Background
Living-donor lobar lung transplantation (LDLLT) is viable for critically ill patients
in situations of donor shortage. Because it is sometimes difficult to find 2 ideal
living donors with suitable graft sizes, we developed native lung-sparing procedures,
including single LDLLT and native upper lobe-sparing LDLLT. This study aimed to investigate
native lung complications (NLCs) in native lung-sparing LDLLT.
Methods
Between April 2002 and March 2019, 92 LDLLTs and 124 cadaveric lung transplantations
(CLTs) were performed at the Kyoto University Hospital. Our prospectively maintained
database and clinical records were reviewed to compare NLCs among recipients who underwent
native lung-sparing LDLLT (n = 21) with those among recipients who underwent single CLT (n = 61).
Results
Among 21 recipients who underwent native lung-sparing LDLLT, 11 NLCs occurred in 8
recipients. No fatal NLC was noted; however, 2 required surgical intervention. Post-transplant
survival was not significantly different between native lung-sparing LDLLT recipients
with NLCs and those without NLCs. The incidence of NLCs was comparable between native
lung-sparing LDLLT recipients and single CLT recipients (8/21 vs 26/61, p = 0.80); however, NLCs occurred significantly later in LDLLT recipients than in CLT
recipients (median: 665 vs 181.5 days after transplantation, p = 0.014).
Conclusions
NLCs after native lung-sparing LDLLT had favorable outcomes. Therefore, native lung-sparing
LDLLT is a useful treatment option for severely ill patients who cannot wait for CLT.
However, it is important to recognize that NLCs may occur later in LDLLT than in CLT.
Keywords
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References
- Outcome of living-donor lobar lung transplantation using a single donor.J Thorac Cardiovasc Surg. 2012; 144: 710-715
- Sparing native upper lobes in living-donor lobar lung transplantation: five cases from a single center.Am J Transplant. 2015; 15: 3202-3207
- Outcomes of various transplant procedures (single, sparing, inverted) in living-donor lobar lung transplantation.J Thorac Cardiovasc Surg. 2017; 153: 479-486
- Native upper lobe-sparing living-donor lobar lung transplantation maximizes respiratory function of the donor graft.J Heart Lung Transplant. 2019; 38: 66-72
- Complications in the native lung after single lung transplantation.Eur J Cardiothorac Surg. 1999; 16: 54-58
- Native lung complications in single-lung transplant recipients and the role of pneumonectomy.J Heart Lung Transplant. 2009; 28: 851-856
- Risk of lung cancer in lung transplant recipients in the United States.Am J Transplant. 2019; 19: 1478-1490
- Clinical application of ET-Kyoto solution for lung transplantation.Surg Today. 2015; 45: 439-443
- Living-donor lobar lung transplantation provides similar survival to cadaveric lung transplantation even for very ill patients dagger.Eur J Cardiothorac Surg. 2015; 47 (discussion 72-3): 967-972
- Less maintenance immunosuppression in lung transplantation following hematopoietic stem cell transplantation from the same living donor.Am J Transplant. 2011; 11: 1509-1516
- Postoperative respiratory management in living donor lobar lung transplantation.Clin Transplant. 2013; 27: E383-E390
- Investigation of the freely available easy-to-use software 'EZR' for medical statistics.Bone Marrow Transplant. 2013; 48: 452-458
- The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: donor and recipient size match.J Heart Lung Transplant. 2019; 38: 1042-1055
- Live related donor lobar lung transplantation recipients surviving well over a decade: still an option in times of advanced donor management.J Cardiothorac Surg. 2013; 8: 37
- Thoracic and cardiovascularsurgery in Japan in 2016: annual report by The Japanese Association for Thoracic Surgery.Gen Thorac Cardiovasc Surg. 2019; 67: 377-411
- Infection in the transplanted and native lung after single lung transplantation.Chest. 1993; 104: 681-685
- Outcome of the native lung after single lung transplant. Multiorgan Transplant Group.Chest. 1995; 107: 981-984
- Native lung complications after single lung transplantation for emphysema.Transpl Int. 1997; 10: 113-115
- Complications (excluding hyperinflation) involving the native lung after single-lung transplantation: incidence, radiologic features, and clinical importance.Radiology. 2001; 218: 233-241
- Quantitative evaluation of native lung hyperinflation after single lung transplantation for emphysema using three-dimensional computed tomography volumetry.Transplant Proc. 2014; 46: 941-943
- Significance of single lung transplantation in the current situation of severe donor shortage in Japan.Gen Thorac Cardiovasc Surg. 2016; 64: 93-97
- Lung cancer: a rare indication for, but frequent complication after lung transplantation.J Thorac Dis. 2016; 8: S915-S924
- High frequency of bronchogenic carcinoma after single-lung transplantation.J Heart Lung Transplant. 2006; 25: 1297-1301
- Living-related lung transplantation.J Thorac Dis. 2017; 9: 3362-3371
Article info
Publication history
Published online: January 23, 2021
Footnotes
List of abbreviations: CLT, cadaveric lung transplantation; COPD, chronic obstructive pulmonary disease; CT, computed tomography; LDLLT, living-donor lobar lung transplantation; NLC, native lung complication; PTLD, posttransplant lymphoproliferative disorder.
Grant support: None.
Identification
Copyright
© 2021 International Society for Heart and Lung Transplantation. All rights reserved.
