Original clinical scienceLong-term outcomes of cadaveric lobar lung transplantation: Helping to maximize resources
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.
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