Living-Donor Lobar Lung Transplantation with Undersized Lobar Grafts Can Provide Comparable Long-Term Pulmonary Function and Exercise Capacity to Cadaveric Lung Transplantation

Abstract

Purpose There has been concern of graft size mismatch due to the use of small lobar grafts for living-donor lobar lung transplantation (LDLLT). The purpose of this study is to compare the post-transplant pulmonary function and exercise capacity between LDLLT and conventional cadaveric lung transplant (CLT) patients. Methods We performed 103 bilateral lung transplants, including 65 LDLLT and 38 CLT, between June 2008 and May 2017. The size matching criteria was as follows: in LDLLT, the calculated forced vital capacity (FVC) of the grafts was > 45% of the recipient predicted FVC; in CLT, the donor predicted vital capacity (VC) was between 70 and 130% of the recipient predicted VC. Pulmonary function and 6-minute walking distance were tested at 1, 3, 6, 12 months, and every year after transplantation. Results The LDLLT patients received significantly smaller grafts than the CLT patients: the mean graft FVC was 65% of the recipient predicted FVC in the LDLLT, whereas the mean donor predicted VC was 98% of the recipient predicted VC in the CLT (P Conclusion LDLLT patients, who received significantly undersized lobar grafts, demonstrated great long-term pulmonary function, exercise tolerance, and survival rates, comparable to the CLT patients.