Original clinical science
Long-term outcomes of cadaveric lobar lung transplantation: Helping to maximize resources

https://doi.org/10.1016/j.healun.2009.09.014Get rights and content

Background

Cadaveric lobar lung transplantation (CLLTx) represents a potential opportunity to address the bias against smaller recipients, especially children, on transplant waiting lists. The widespread use of CLLTx is hindered by the paucity of outcome data with respect to early complications and long-term lung function and survival.

Methods

We looked at the long-term outcomes in 9 patients undergoing CLLTx since May 2003, including early surgical complications, pulmonary function tests, and survival. Patients were analyzed by whether the decision to perform CLLTx was elective (made at the time of listing) or emergent (surgical decision).

Results

The incidence of early complications in the entire group was low, with the most common being atrial arrhythmias and prolonged thoracostomy tube. Lung function at 1 and 2 years (mean forced expiratory volume in 1 second % predicted ± standard deviation of 73 ± 18 and 60.5 ± 27, respectively) was equivalent to living lobar transplant results. Overall survival was similar to 199 patients who received conventional cadaveric LTx during the same period.

Conclusion

This study suggests that CLLTx has a low complication rate with acceptable lung function and long-term survival, especially in cases where consideration has been given to CLLTx at the time of listing. CLLTx warrants consideration more often for patients of smaller physique to improve their chance of receiving LTx.

Section snippets

Patient characteristics

Since May 2003, 208 LTxs were performed (40 single and 168 bilateral LTx), and 9 patients (8 female; age range, 9–66 years) underwent CLLTx (Table 1). The mean time on the waiting list was 268 days (range, 50–835 days). The mean lung allocation score for the cohort was 33.61 (range, 28.81–41.25), with the elective cases having a slightly higher mean than the emergent group (33.73 vs 33.35). LTx was bilateral in 8 and single in 1. Expected difficulties in size matching at the time of LTx

Results

The overall mean operation time was 481 minutes (range, 300–660 minutes). Mean ischemic time was 331 minutes (range, 187–700 minutes). The procedure was well tolerated, reflected in the median intensive care unit length of stay (LOS) of 8 days (range, 0–36 days) and total hospital LOS of 29 days (range, 10–62 days). A compendium of the complications associated with the procedures is summarized in Table 2.

Early post-operative complications were documented in the elective group in Patient 9, who

Discussion

Lobar resection during LTx has been used in a number of settings, with size mismatching preemptively envisaged at the time of listing, encountered at the time of transplantation, or as part of a strategy to maximize marginal donor organs.18 Poor size matching can lead to ventilatory dysfunction, atelectasis, and hemodynamic instability, with over-sizing mismatch experiments in dogs showing significant lung function reduction after chest closure.19, 20 As a result, lobar LTx is among the

Disclosure statement

None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

References (24)

Cited by (29)

  • Anesthesia for Lung Transplantation in Cystic Fibrosis: Retrospective Review from the Irish National Transplantation Centre

    2018, Journal of Cardiothoracic and Vascular Anesthesia
    Citation Excerpt :

    Reduced size lung transplantation has been proposed to overcome the lack of suitably sized lungs for smaller recipients, including CF patients. It has been shown that bilateral lobar lung transplantation has outcomes comparable with those of standard bilateral lung transplantation.18 Twenty patients in the cohort (49%) were extubated by the end of the first postoperative day.

  • Bronchopleural fistula after bilateral sequential lobar lung transplantation: Technical details of a successful repair

    2015, Journal of Thoracic and Cardiovascular Surgery
    Citation Excerpt :

    On the back table, pulmonary vessels in this setting are not distended with blood flow, making the delineation of the anatomy challenging at times. Thus, lower lobectomy is easier, because fissures are more predictably complete.5 Upper lobectomies result in most of the lung parenchyma sitting below the hilar structures, which may create an apical space issue.5

  • Current Status of Lung Transplantation

    2014, Regenerative Medicine Applications in Organ Transplantation
  • Lobar lung transplantation: A relevant surgical option in the current era of lung allocation score

    2013, Annals of Thoracic Surgery
    Citation Excerpt :

    Although further long-term observation is warranted, given the critically ill condition of the patients in the current series and narrow window for transplant, these results are very encouraging. Published studies have suggested that LLT does not increase the morbidity or mortality of lung transplantation [6, 8]. Based on the results shown in this study, we agree that LLT appears to be safe with acceptable procedure-related risks.

  • Lobar Lung Transplantation: Emerging Evidence for a Viable Option

    2013, Seminars in Thoracic and Cardiovascular Surgery
View all citing articles on Scopus
View full text