Elsevier

Transplantation Proceedings

Volume 36, Issue 9, November 2004, Pages 2801-2805
Transplantation Proceedings

Thoracic transplanation
Outcomes
Size-reduced lung transplantation: An advanced operative strategy to alleviate donor organ shortage

https://doi.org/10.1016/j.transproceed.2004.09.066Get rights and content

Abstract

Background

The increasing need for donor lungs, especially for small and pediatric recipients, has not been matched by an adequate supply. This disparity has stimulated the development of new operative techniques, which allow downsizing of larger lungs for use in smaller recipients, thus potentially expanding the donor pool. This approach has recently gained more widespread use, especially for highly urgent recipients; however, is still not considered a standard procedure.

Patients and methods

All primary size-reduced lung transplants performed from January 2001 to December 2003 were retrospectively reviewed. Downsizing was achieved by either split-lung transplantation, lobar transplantation, or by means of a peripheral wedge resection. Waiting list time, perioperative complications, and outcomes of those patients were compared to patients undergoing primary standard single or double lung transplantation during the observation period.

Results

Among 163 primary lung transplantations 51 (31.3%) were size-reduced procedures. Size reduction was achieved by lobar transplantation (n = 18), split-lung transplantation (n = 2), or peripheral segmental resection (n = 31). There was a slightly decreased waiting time among the size-reduced group (74 ± 72 vs 98 ± 90 days, P = .13). No statistically significant difference between the size-reduced and the standard lung transplantation group was evident with regard to the rate of bronchial healing problems (n = 3/9; P = .62) or the rate of revision due to postoperative bleeding (n = 6/15; P = .77). No other major thoracic surgical complications were observed. The 3-month survival rate was 86.3% in the size-reduced 92.0% in the standard group (P = .09).

Conclusion.

Size-reduced lung transplantations, including split-lung transplantation, lobar transplantation, and peripheral segmental resection, may be considered reliable procedures that provide results comparable to standard lung transplantation. It allows the use of oversized grafts for small and pediatric recipients and the use of single lobes if localized pathologies exist, thus enlarging the donor pool and potentially helping to reduce waiting times and waiting list mortality.

Section snippets

Patients and methods

This report retrospectively reviews our experience from January 2001 to December 2003 with cadaveric size-reduced lung transplantation, including split-lung transplantation, lobar transplantation, and downsizing by means of peripheral wedge resections, with regard to waiting time implications, perioperative complications, and outcomes.

One hundred sixty three patients underwent primary lung transplantation at our institution during the observation period. Size-reduced lung transplantation was

Results

Within the observation period 51 (31.3%) of 163 primary lung transplantations were size-reduced. Size reduction was achieved by lobar transplantation (n = 18), split-lung transplantation (n = 2), or peripheral segmental resection (n = 31). As one might expect the patients receiving size-reduced organs were significantly younger (39.56 ± 15.65 vs 48.65 ± 14.82 years; P < .001) and the underlying diagnoses different from those receiving standard lung transplants (Fig 1). Two patients in the

Discussion

Donor organ scarcity is one of the major limitations in lung transplantation today. Various methods are used to exploit available donor organs and if possible increase the donor pool. Especially for small adult and pediatric recipients, downsizing of donor lungs may considerably increase the donor pool, since it allows the use of larger donor organs for these patients. Downsizing can also be applied and increase the available donor organs if a localized pathology is found in one donor lobe.

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