Comparison of Outcomes of Living-Donor Lobar and Cadaveric Lung Transplantation in Patients with Pulmonary Arterial Hypertension

Abstract

Purpose Lung transplantation is indicated in patients with severe pulmonary arterial hypertension (PAH). Living donor lobar lung transplantation (LDLLT) may be considered in patients who might not survive the longer waiting duration for cadaveric lung transplantation (CLT). This study compared the outcomes of LDLLT and CLT in patients with PAH. Methods Retrospective review of medical records from our institutional database between April 2008 and August 2018 revealed 191 lung transplants, of which 6 LDLLTs and 10 CLTs were performed for PAH patients, defined based on the criteria for group 1 of the Nice classification. Results Preoperatively, LDLLT and CLT groups showed no significant differences in age (median 14 vs. 29.5 years, p=0.08), height (median 155 vs. 160 cm, p=0.91), mean pulmonary arterial pressure (PAP) (median 60.5 vs. 57.0 mmHg, p=0.96), brain natriuretic peptide (median 153 vs. 89.0 pg/mL, p=0.36), and dose of intravenous epoprostenol (median 29.7 vs. 65.2 ng/kg/min, p=0.55). All cases of LDLLT were bilateral, except one performed in a pediatric patient. In 2 cases, bilateral LDLLTs were performed by preserving the upper lobes for size mismatch. After surgery, extracorporeal cardiopulmonary support was required in 5 LDLLT cases and 4 CLT cases (p= 0.384). One hospital death occured on day 192 due to sepsis in the CLT group. The median postoperative PAP was 16.5 mmHg and 14.0 mmHg (p=0.213) and the ratio between the pre- and postoperative mean PAP were 26.6% and 26.4% (p=0.456) in the LDLLT and CLT groups, respectively. The median follow-up period was 57.5 and 22.5 months and the five-year survival was 100% and 88.9% (p=0.41) in LDLLT and CLT groups, respectively. Conclusion LDLLTs were associated with acceptable outcomes in patients with PAH and were not inferior to CLTs. Thus, for patients with severe progressive PAH, LDLLTs may be a lifesaving procedure. Lung transplantation is indicated in patients with severe pulmonary arterial hypertension (PAH). Living donor lobar lung transplantation (LDLLT) may be considered in patients who might not survive the longer waiting duration for cadaveric lung transplantation (CLT). This study compared the outcomes of LDLLT and CLT in patients with PAH. Retrospective review of medical records from our institutional database between April 2008 and August 2018 revealed 191 lung transplants, of which 6 LDLLTs and 10 CLTs were performed for PAH patients, defined based on the criteria for group 1 of the Nice classification. Preoperatively, LDLLT and CLT groups showed no significant differences in age (median 14 vs. 29.5 years, p=0.08), height (median 155 vs. 160 cm, p=0.91), mean pulmonary arterial pressure (PAP) (median 60.5 vs. 57.0 mmHg, p=0.96), brain natriuretic peptide (median 153 vs. 89.0 pg/mL, p=0.36), and dose of intravenous epoprostenol (median 29.7 vs. 65.2 ng/kg/min, p=0.55). All cases of LDLLT were bilateral, except one performed in a pediatric patient. In 2 cases, bilateral LDLLTs were performed by preserving the upper lobes for size mismatch. After surgery, extracorporeal cardiopulmonary support was required in 5 LDLLT cases and 4 CLT cases (p= 0.384). One hospital death occured on day 192 due to sepsis in the CLT group. The median postoperative PAP was 16.5 mmHg and 14.0 mmHg (p=0.213) and the ratio between the pre- and postoperative mean PAP were 26.6% and 26.4% (p=0.456) in the LDLLT and CLT groups, respectively. The median follow-up period was 57.5 and 22.5 months and the five-year survival was 100% and 88.9% (p=0.41) in LDLLT and CLT groups, respectively. LDLLTs were associated with acceptable outcomes in patients with PAH and were not inferior to CLTs. Thus, for patients with severe progressive PAH, LDLLTs may be a lifesaving procedure.