(814) - The Impact of Incomplete Pulmonary Fissures of Living Lobar Lung Transplant Donors on Bronchial Stenosis of Lung Recipients

Abstract

Bronchial complications are among the most challenging problems after living-donor lobar lung transplantation (LDLLT), although the ischemic time of living-donor lungs can be minimized compared to cadaveric lung transplantation. To prevent bronchial complications, maintaining the pulmonary blood flow is critical for the bronchial healing. However, in the donor lobectomy of LDLLT, the inadequate dissection of interlobar fissures could cause unexpected obstruction of the pulmonary vessels and decreased blood flow to the bronchial anastomosis. The purpose of this study was to examine the relationships between incomplete pulmonary fissures of living-donor lungs and bronchial stenosis of LDLLT recipients. We retrospectively analyzed 127 donors and 69 recipients of bilateral and unilateral LDLLT at our institution between October 1998 and October 2013. According to Craig’s classification of pulmonary fissures, interlobar fissures of donor lungs were Grade 1 in 43, Grade 2 in 73, Grade 3 in 11 and Grade 4 in no donor. Postoperative lung perfusion scintigraphy was available in 119 of 127 transplanted lungs after LDLLT. Lung perfusion scintigraphy showed segmental defect or reduced blood flow in the lobar apex in 12 transplanted lungs (Group A), and homogenous distribution of blood flow in 107 transplanted lungs (Group B). Grade of interlobar fissures in Group A was significantly higher than that in Group B (2.1 ± 0.15 v.s. 1.7 ± 0.059; p < 0.05). While 3 of 12 (25 %) transplanted lungs in Group A revealed bronchial stenosis after LDLLT, no bronchial stenosis was encountered in 107 transplanted lungs of Group B. Our experience suggests that the incomplete pulmonary fissure of living-donors is a possible risk factor for bronchial stenosis of lung recipients in LDLLT. Careful dissection of incomplete pulmonary fissures should be required to maintain the pulmonary blood flow in the living-donor lobectomy.