Bilateral Living-donor Lobar Lung Research Articles

Early Detection of Chronic Lung Allograft Dysfunction After Bilateral Living Donor Lobar Lung Transplantation by Computed Tomographic Scanning Scoring Method

In common bilateral living-donor lobar lung transplantation (LDLLT), two allografts with different antigenicity are transplanted simultaneously. As a result, different immune reactions occur in each side of the allograft that would degrade individually. Therefore, the accuracy of conventional spirometry based detection for chronic lung allograft dysfunction (CLAD) is limited. The purpose of this study was to examine whether computed tomographic scanning (CT) evaluation on an allograft basis enable earlier diagnosis of CLAD than conventional spirometry in this kind of population.

(861) - Intermediate-Term Change of Pulmonary Function and Lung Volume after Bilateral Living Donor Lobar Lung Transplantation

(861) - Intermediate-Term Change of Pulmonary Function and Lung Volume after Bilateral Living Donor Lobar Lung Transplantation

Living-donor lobar lung transplantation for rapidly progressive interstitial pneumonia associated with clinically amyopathic dermatomyositis: report of a case

Diffuse interstitial pneumonia (IP) associated with collagen disease is a rare indication for lung transplantation. The manifestations of collagen disease are variable and dermatomyositis (DM) is often considered a contraindication for lung transplantation because of active myositis and a high incidence of malignancy. Furthermore, clinically amyopathic dermatomyositis (C-ADM) is associated with rapidly progressive IP resulting in a poor prognosis. Bilateral living-donor lobar lung was transplanted in a 52-year-old female with rapidly progressive IP associated with C-ADM, and the postoperative course was uneventful. To our knowledge, this case represents the first living-donor lobar lung transplantation for a patient with rapidly progressive IP associated with C-ADM.

Balloon angioplasty for pulmonary artery stenosis after lung transplantation

We report here a successful case of balloon angioplasty for a stenosis of the pulmonary artery after lung transplantation. A 49-year-old patient with end stage diffuse bronchiectasis with sinusitis underwent bilateral living donor lobar lung transplantation. After treatment of postoperative right pneumothorax, a perfusion lung scan revealed deficient perfusion in the left lung. Pulmonary angiography showed a severe stenosis in the left pulmonary artery just distal to the anastomosis. Percutaneous balloon angioplasty improved both pulmonary perfusion and respiratory function.

Peripheral Lung Volume Reduction Improved Early Graft Function in Severe Size Mismatched Living Donor Lobar Lung Transplantation

Background Lung transplantation from adults to infants or small children is still challenging because of concerns related to size disparity. Peripheral lung volume reduction for size disparity in cadaveric donor lung transplantation has been widely performed; however, little is known about the efficacy and the functional outcomes of downsizing the implanted lobes for severe size disparity in living donor lobar lung transplantation. Methods Thirteen size-mismatched (donor/recipient lung volume ratio >2.82) bilateral living donor lobar lung transplants were performed with (reduction group, n = 6) or without (no-reduction group, n = 7) peripheral lung volume reduction. Results On spontaneous respiration, PaO 2 in the reduction group was significantly higher than that in the no-reduction group ( P < .01) and PaCO 2 in the reduction group was significantly lower than that in the no-reduction group ( P < .001). Pulmonary vascular resistance in the reduction group remained significantly lower than that in the no-reduction group throughout the assessment periods after chest closure ( P < .05). Peak airway pressure in the no-reduction group increased significantly at the time of chest closure ( P < .001) and remained significantly higher than that in the reduction group throughout the assessment period on mechanical ventilation ( P < .01). The percentage of weight reduced from implanted grafts significantly correlated with donor/recipient lung volume ratio ( r = 0.82, P < .05). Conclusions Peripheral lung volume reduction is useful to improve early graft function in severe size mismatched experimental living donor lobar lung transplantation. The technique might allow for further flexibility in donor size and for increasing the donor pool for small recipients.

Screening potential donors for living donor lobar lung transplantation

Bilateral living donor lobar lung transplantation requires 2 live donors per transplant candidate. The Live Donor Consensus Conference Guidelines for accepting donors for lobar transplantation include: individuals in good health; age 18 yrs-55 yrs; normal PFTs; normal ABG on room air; normal weight-for-height; must be taller than proposed recipient; and have no significant cardiopulmonary disease. Pre-screening candidates is essential to reduce overall costs and conserve resources. Subsequent evaluation of potential donors who pass the pre-screening process is expensive and time-consuming. To date, no one has reported the number of candidates who are pre-screened and eventually evaluated in order to select 2 donors. A cohort of 28 consecutive bilateral lobar lung transplant recipients were reviewed to determine the number of lobar donors who were evaluated and the primary reason for not being accepted. A total of 220 (138 M:82 F) were referred for lobar donor evaluation by potential recipients and their families. 164 pts (almost 75%) were not accepted as lobar donors. The average number was 8 (range 2-29) potential donors screened per lung transplant candidate. The primary reasons for not accepting a lobar donor: decreased expiratory flows 55 pts (33.5%); height 32 pts (19.5%); did not want to donate 18 pts (11%); not accepted for miscellaneous medical/social reasons by transplant team 18 pts (11%); too obese 12 pts (7.3%); and too old 9 pts (5.5%). Although 2/total 28 (7%) lobar recipients required only 2 donors screened, the majority of lobar candidates required more donor evaluations. While lobar transplant is an option for critically ill patients, the need to evaluate more than 2 potential donors, as well as the time necessary to properly screen lobar donors safely, supports the concept that this surgery should not be considered as a routine emergent procedure. Living lobar transplant requires the ability to screen multiple potential donors in a time-effective manner to maintain both cost effectiveness and recipient/donor safety.

Pediatric Recipients of Living Donor Lobar Lung Transplants: Postoperative Care

Bilateral living donor lobar lung transplantation is a treatment option for selected children and adults with end-stage lung disease. Careful donor evaluation, skilled intraoperative management and surgical technique, and diligent immediate postoperative care and follow-up all contribute to better outcomes. Although medical management of whole lung transplant recipients in the immediate postoperative period is similar to that of lobar lung transplant recipients, there are specific differences. Anatomical distinctions, such as the entire cardiac output flowing to 2 lobes instead of 5, and thoracic space issues with simultaneous mechanical ventilation and chest tube suction, contribute to these differences. Early postoperative care, including initial postoperative stabilization, ventilation, fluid management, rejection/infection surveillance and prophylaxis, and beginning rehabilitation, can be adapted to ensure successful outcomes in these patients.

Pediatric recipients of living donor lobar lung transplants: postoperative care.

Bilateral living donor lobar lung transplantation is a treatment option for selected children and adults with end-stage lung disease. Careful donor evaluation, skilled intraoperative management and surgical technique, and diligent immediate postoperative care and follow-up all contribute to better outcomes. Although medical management of whole lung transplant recipients in the immediate postoperative period is similar to that of lobar lung transplant recipients, there are specific differences. Anatomical distinctions, such as the entire cardiac output flowing to 2 lobes instead of 5, and thoracic space issues with simultaneous mechanical ventilation and chest tube suction, contribute to these differences. Early postoperative care, including initial postoperative stabilization, ventilation, fluid management, rejection/infection surveillance and prophylaxis, and beginning rehabilitation, can be adapted to ensure successful outcomes in these patients.