Native Lung Complications after Living-Donor Lobar Lung Transplantation

Abstract

Given the severe donor shortage in Japan, living-donor lobar lung transplantation (LDLLT) is a viable option for critically ill patients. Furthermore, native lung-sparing procedures, such as single lobe transplantation and native upper lobe-sparing transplantation, have been performed due to the difficulty in finding two ideal donors. Like single cadaveric lung transplantation (CLT), spared native lungs may become sources of complications in LDLLT procedures. The objective of this study was to further understand native lung complications (NLCs) in LDLLT. Between April 2002 and March 2019, 216 lung transplants (92 LDLLTs and 124 CLTs) were performed at Kyoto University Hospital. Our prospectively maintained database and clinical records were queried to identify recipients who underwent native lung-sparing LDLLT and NLCs. Recipients who underwent a single CLT were also reviewed, and NLCs were compared between LDLLT and CLT. Among the 21 recipients who underwent native lung-sparing LDLLT (10 single and 11 native upper lobe-sparing), 10 NLCs occurred in seven (33%) recipients. The types of complications were as follows: pneumothorax (n=4), infection (n=2), organizing pneumonia (n=2), pulmonary embolism (n=1), and post-transplant lymphoproliferative disorders (PTLD) (n=1). None of the above NLCs were fatal, although two patients required surgical intervention. Post-transplant survival was not significantly different between recipients with and recipients without NLCs (5-year survival rate 68.6% vs 85.7%, p=0.41). Survival was also not significantly different between LDLLT recipients who underwent native lung-sparing procedures and those who underwent standard procedures (5-year survival rate 80.6% vs 83.4%, p=0.87). The incidence of NLCs was similar between single CLT and native lung-sparing LDLLT (25/59 vs 7/21, p=0.61). NLCs occurred significantly later in the CLT group than in the LDLLT group (529 days vs 180.5 days of median after transplantation, p=0.041). NLCs after native lung-sparing LDLLT were successfully treated with a favorable outcome. Therefore, native lung-sparing LDLLT may be a useful treatment option for severely ill patients, despite the possibility of NLCs. However, it is important to keep in mind that NLCs may occur later in LDLLT than in CLT.