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DOI: 10.1055/s-0036-1571690
Up to Six Years Experience of Lobar Lung Transplantation
Objectives: The shortage of suitable donor organs is a problem in lung transplantation. This dilemma is even worse in recipients with small chest cavities. To exploit a larger donor pool, we electively accepted bigger organs for small patients and performed lobar lung transplants. We further compared this patient group with patients receiving regular bilateral lung transplantation concerning survival and lung function.
Methods: In our lung transplant program 10 patients (8 women and 2 men, 45.9 ± 12.2 years old) received elective lobar lung transplantation between March 2009 and August 2014. with a mean waiting time of 227 ± 163 days. The underlying diseases were IPF (n = 6), CF (n = 3) and PHT (n = 1). The mean recipient height was 164 ± 8 cm and their calculated total lung capacity (TLC) was 5.3 ± 1.0 L.
Results: Donor lungs from 9 males and 1 female with a calculated TLC of 7.7 ± 0.3 L and 5.3 L and a donor height of 185 ± 4 cm and 165 cm respectively were accepted. Mean donor age was 44.9 ± 7.2 years. All recipients were successfully transplanted via antero-lateral or clamshell incisions using intraoperative ECMO support. In 5 cases, we transplanted a right upper (RUL) + right middle lobe (RML) and a left upper lobe (LUL). The remaining patients received RUL and LUL (n = 2), RLL and LLL (n = 2), and RML + RLL and LLL (n = 1). There were no postoperative complications needing further interventions. The 30-day survival was 90%. The one year survival was 72.7%. All other patients are still alive in 09/2015 at 47.3 ( ± 23.3) months. The Kaplan-Meier curve is slightly better compared with our patients, who received regular bilateral lung transplantation (n = 49). Cause of death (n = 3) during the first year were graft failure (day 11), encephalopathy (day 77) and sepsis (day 134). Further complications have been BOS at stage III in one patient and 10 hospitalizations due to infections at some point. All survivors are followed in an outpatient clinic. Their last measured VC and FEV1 was 64.7 ± 18.7% and 58.3 ± 11.3%, respectively. This is again comparable to our regular lung transplants.
Conclusion: In this study it is shown that elective lobar lung transplantation can be performed safely with similar overall results as regular lung transplants. It is an option for patients, mainly female with small thoraces
Fig. 1 Lobar vs bilateral LuTx.