(1019) - Cadaveric Lobar Lung Transplantation Based on the Experiences of Living-Donor Lobar Lung Transplantation

Abstract

Donor shortages in lung transplantation (LT) continue to be problematic for pediatric and small adult patients due to graft size incompatibility issues. As a solution to this problem, the usefulness of cadaveric lobar LT (CLLT) has been recently reported, and CLLT has been shown to provide favorable outcomes. However, because several technical points required elaboration in CLLT, the techniques of CLLT have not been widely adopted. Based on our experiences of living-donor lobar LT (LDLLT), we applied the techniques of LDLLT to CLLT. The purpose of this study was to examine the outcomes of CLLT and provide a description of the techniques of CLLT at our institution. We retrospectively investigated 8 recipients who underwent CLLT, of 145 LT recipients at our institution between October 1998 and October 2015. The median age at the time of cadaveric LT was 34 years (14-54 years). The male-to-female ratio was 1:1. Four of 8 patients had pulmonary fibrosis characterized by the reduced chest cavity. All 8 patients underwent bilateral LT after the anatomic lobectomy of 1 or 3 lobes. The cause of lobectomy was pneumonia in 5 patients and oversized graft in 3 patients. All 8 patients required cardiopulmonary bypass during CLLT. Although 3 patients required tracheostomy for primary graft dysfunction, no patients required extracorporeal membrane oxygenation after LT. Three of 8 patients had bronchial stump after lobectomy, and no patient encountered bronchopleural fistula. One patient who underwent the right lower lobectomy, developed vanishing bronchus intermedius syndrome, requiring stent insertion. After we changed the method to transect the bronchus at the level of the lobar bronchus as in LDLLT, we did not encounter bronchial complications. Survival analysis showed no significant difference between CLLT group and the other LT patients from our institution. CLLT could be a safe and effective option for pediatric and small adult recipients. In CLLT, the bronchus should be transected not to form the bronchial stump.