Living-donor lobar lung transplantation

Abstract

Living-donor lobar lung transplantation (LDLLT) was developed to offset the mismatch between supply and demand for those patients awaiting deceased donor lung transplantation (DDLT). LDLLT was introduced by Starnes and his colleagues as an alternative form of treatment for patients who had a decline in their physical condition and a limited life expectancy. A single donor was used at the outset, and successful living-donor single-lobe transplantation has been reported [1]. However, the subsequent experience with single-lobe transplantation was not satisfactory. Therefore, Starnes’ group developed bilateral LDLLT in which two healthy donors donate their right or left lower lobes (Fig. 5.1) [2]. Since then, bilateral LDLLT has been performed as a lifesaving procedure to deal with the shortage of deceased donors. Because only two lobes are transplanted, LDLLT seems to be best suited for children and small adults, and initially it was applied almost exclusively to patients with cystic fibrosis [3]. However, it is now established that LDLLT can be applied to both pediatric and adult patients with restrictive, obstructive, infectious, and vascular lung diseases when the size matching is acceptable [4–6]. Successful LDLLTs have been reported for patients receiving oversized as well as undersized grafts. In our institution, the 5-year survival after LDLLT is 88.2%.