Living-donor lobar lung transplantation for various lung diseases

Date, Hiroshi; Aoe, Motoi; Nagahiro, Itaru; Sano, Yoshifumi; Andou, Akio; Matsubara, Hiromi; Goto, Keiji; Tedoriya, Takeo; Shimizu, Nobuyoshi

doi:10.1016/s0022-5223(03)00235-6

Cited by 112 publications

(99 citation statements)

References 15 publications

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“…8 For control experiments, pulmonary artery samples were taken from 5 patients with bronchogenic carcinoma (4 men and 1 woman; mean age, 59.0Ϯ4.1 years), who had no evidence of pulmonary hypertension at the time of lung lobectomy. Samples of the pulmonary arteries were obtained from the most distal area from the carcinoma in the resected lobe.…”

Section: Isolation Of Pulmonary Artery Smcsmentioning

confidence: 99%

Prednisolone Inhibits Proliferation of Cultured Pulmonary Artery Smooth Muscle Cells of Patients With Idiopathic Pulmonary Arterial Hypertension

et al. 2005

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Background-Idiopathic pulmonary arterial hypertension (IPAH) is associated with proliferation of smooth muscle cells (SMCs) in small pulmonary arteries. There is no therapy that specifically inhibits SMC proliferation. Recent studies reported that prednisolone (PSL) inhibits the postangioplasty proliferation of SMCs in atherosclerotic arteries. In this study, we tested the hypothesis that PSL has antiproliferative effects on pulmonary artery SMCs of patients with IPAH. Methods and Results-Pulmonary artery SMCs were harvested from the pulmonary arteries of 6 patients with IPAH who underwent lung transplantation. Control SMCs were obtained from 5 patients with bronchogenic carcinoma who underwent lung lobectomy. After incubation in the presence of platelet-derived growth factor (PDGF), PSL was added at different concentrations and cell proliferation was assessed by 3 H-thymidine incorporation. PSL (2ϫ10 Ϫ4 and 2ϫ10

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Section: Isolation Of Pulmonary Artery Smcsmentioning

confidence: 99%

Prednisolone Inhibits Proliferation of Cultured Pulmonary Artery Smooth Muscle Cells of Patients With Idiopathic Pulmonary Arterial Hypertension

et al. 2005

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“…According to our previous experiences, an acceptable predictive donor lung size compared with a recipient's predictive FVC is !45% to 50% (8 In LDLLT using such a boundary for donor graft size, transplanting even approximately 5% larger grafts would be advantageous in many aspects. As we reported previously, donor grafts increased in volume over time, reaching 120% AE 38% of the original values at 12 months postoperatively (10).…”

Section: Discussionmentioning

confidence: 99%

“…Her husband was the only eligible donor for LDLLT. Based on the actual FVC, his RLL was estimated to provide 44.6% of the recipient's predicted FVC, which would provide the borderline function required for LDLLT (8,10). In contrast, his LLL was estimated to provide an insufficient 35.8% of the recipient's predicted FVC ( Table 1).…”

Section: Casementioning

confidence: 99%

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Right and Left Inverted Lobar Lung Transplantation

Chen

Miyamoto

Takemoto

et al. 2015

American Journal of Transplantation

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Adult recipients frequently withdraw from livingdonor lobar lung transplantation because of the small size of donor grafts. The right lower lobe is 120% larger than the left lower lobe. We developed a novel surgical technique in which an inverted right lower lobe graft can be transplanted into the left thorax. The first patient was a 43-year-old woman with end-stage idiopathic interstitial pneumonia. Her husband was the only eligible donor for living-donor lobar lung transplantation. His right lower lobe was estimated to provide 45% of the recipient's predicted forced vital capacity, which would provide the borderline function required for living-donor lobar lung transplantation. Since lung perfusion scintigraphy of the recipient showed a right-to-left ratio of 64:36, transplanting the right lower lobe graft into the left thorax and sparing the native right lung was considered the only treatment option. We simulated this procedure using three-dimensional models produced by a three-dimensional printer. In living-donor lobar lung transplantation, all anastomoses were performed smoothly as planned preoperatively. Because of the initial success, this procedure was performed successfully in two additional patients. This procedure enables larger grafts to be transplanted, potentially solving critical size matching problems in livingdonor lobar lung transplantation.

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“…It is now well known that LDLLT can be applied to various indications including restrictive, obstructive, infectious and vascular diseases (3)(4)(5)(6)(7). Although LDLLT was developed in the USA, its use has decreased there due to the recent change in lung allocation system.…”

Section: Introductionmentioning

confidence: 99%

Living-related lung transplantation

Date

2017

J. Thorac. Dis.

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Living-donor lobar lung transplantation (LDLLT) was developed to deal with the severe shortage of brain dead door for patients who would not survive the long waiting period. In standard LDLLT, right and left lower lobes removed from two healthy donors are implanted into a recipient after right and left pneumonectomies using cardiopulmonary bypass (CPB). The number of LDLLT has decreased in the USA due to the recent change in allocation system for cadaveric donor lungs. For the past several years, most of the reports on LDLLT have been from Japan, where the average waiting time for a cadaveric lung is exceeding 800 days. LDLLT has been performed both for adult and pediatric patients suffering from various end-stage lung diseases including restrictive, obstructive, vascular and infectious lung diseases. Since only two lobes are implanted, size matching is a very important issue. Functional size matching by measuring donor pulmonary function and anatomical size matching by three-dimensional computed tomography (3D-CT) volumetry are very useful. For oversize graft, we have employed several techniques, including single lobe transplantation, delayed chest closure, downsizing the graft, and middle lobe transplantation. In cases of undersize mismatch, native upper lobe sparing transplant or right-left inverted transplant was performed.The 5-, 10-and 15-year survivals were 80.8%, 72.6% and 61.7%, respectively. There was no difference in survival between standard LDLLT and non-standard LDLLT such as single, sparing and inverted transplant.All donors have been discharged without any restrictions. LDLLT is a viable option for very ill patients who would not survive a long waiting time for cadaveric lungs. We have successfully developed various surgical techniques to overcome size mismatching with favorable outcome.

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Living-donor lobar lung transplantation for various lung diseases

Abstract: Living-donor lobar lung transplantation can be applied to restrictive, obstructive, septic, and hypertensive lung diseases. This type of procedure can be an alternative to conventional cadaveric lung transplantation for both pediatric and adult patients who would die soon otherwise.

Cited by 112 publications

References 15 publications

Prednisolone Inhibits Proliferation of Cultured Pulmonary Artery Smooth Muscle Cells of Patients With Idiopathic Pulmonary Arterial Hypertension

Prednisolone Inhibits Proliferation of Cultured Pulmonary Artery Smooth Muscle Cells of Patients With Idiopathic Pulmonary Arterial Hypertension

Right and Left Inverted Lobar Lung Transplantation

Living-related lung transplantation

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