Original article
General thoracic
Inverted Lobes Have Satisfactory Functions Compared With Noninverted Lobes in Lung Transplantation

Presented at the Thirty-seventh Annual Meeting and Scientific Sessions of the International Society for Heart & Lung Transplantation in San Diego, CA, April 5–8, 2017.
https://doi.org/10.1016/j.athoracsur.2017.11.034Get rights and content

Background

To overcome the problem of small-for-size grafts in standard living-donor lobar lung transplantation (LDLLT), we developed inverted LDLLT, in which a right lower lobe from 1 donor is implanted as a right graft and another right lower lobe from another donor is implanted as a left graft. We retrospectively analyzed the functions of inverted grafts vs noninverted grafts.

Methods

Between 2008 and 2015, 64 LDLLTs were performed. Included were 35 LDLLTs whose recipients were adults and monitored for more than 6 months without developing chronic lung allograft dysfunction. Among them, 65 implanted lobes were eligible for this analysis. There were 31 right lower lobes implanted as right grafts (right-to-right group), 7 right lower lobes as inverted left grafts (right-to-left group), and 27 left lower lobes as left grafts (left-to-left group). We evaluated the graft forced vital capacity (G-FVC) and graft volume of the 65 lobes before and 6 months after LDLLT and compared them among the three groups.

Results

Preoperatively, G-FVC in the right-to-left group (1,050 mL) was comparable to that in the right-to-right group (1,177 mL) and better than that in the left-to-left group (791 mL, p < 0.01). Six months after LDLLT, G-FVC in the right-to-left group (1,015 mL) remained comparable to that in the right-to-right group (1,001 mL) and better than that in the left-to-left group (713 mL, p = 0.047). The ratio of graft volume 6 months after LDLLT to the preoperative value was comparable.

Conclusions

The functions of inverted grafts in inverted LDLLTs were satisfactory compared with those of noninverted grafts.

Section snippets

Patients and Methods

This study was approved by the Kyoto University Institutional Review Board. Between 2008 and 2015, 125 lung transplantations were performed at Kyoto University Hospital. Among these cases, 64 patients underwent LDLLT. After excluding 29 patients, including pediatric patients, those undergoing bilateral native lung–sparing LDLLT or retransplantation, and patients who died or developed chronic lung allograft dysfunction within 6 months or could not undergo pulmonary function testing at 6 months

Patient Characteristics

Among 35 adult recipients (15 men, 20 women), the median age was 51 years (range, 22 to 63 years). Bilateral LDLLT was performed in 34patients and single inverted LDLLT in 1 patient. The 34 LDLLTs consisted of 25 standard bilateral LDLLTs, 5 inverted bilateral LDLLTs, 1 inverted bilateral LDLLT combined with the unilaterally native-sparing technique, and 3 unilaterally native-sparing bilateral LDLLT (Table 1).

The most frequent indication was interstitial pneumonia (n = 18), followed by

Comment

In this analysis, we found two important findings concerning graft function and graft volume and one important finding concerning the donor outcomes in LDLLT. The postoperative graft function of the inverted right lower lobe was significantly better than that of the left lower lobe and equivalent to that of the noninverted right lower lobe. The postoperative graft volume of the inverted right lower lobe was significantly larger than that of the left lower lobe and equivalent to that of the

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© 2018 by The Society of Thoracic Surgeons Published by Elsevier