Lobar transplantation, split lung transplantation and peripheral segmental resection – reliable procedures for downsizing donor lungs

Aigner, Clemens; Mazhar, Samy; Jaksch, Péter; Seebacher, Gernot; Taghavi, S.; Marta, Gabriel; Wisser, Wilfried; Klepetko, Walter

doi:10.1016/j.ejcts.2003.11.009

Cited by 94 publications

(56 citation statements)

References 7 publications

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“…In deceased-donor lung transplantation, several surgical modifications have been performed to counter the severe donor shortage worldwide, such as pulmonary bipartitioning, lobar transplantation, and inverted left lung transplantation into the right thorax (12)(13)(14)(15)(16). In LDLLT, native lungsparing bilateral LDLLT and single LDLLT with contralateral lung resection also have been reported (17,18); however, there are no reports of right and left inverted lobar lung transplantation.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Right and Left Inverted Lobar Lung Transplantation

Chen

Miyamoto

Takemoto

et al. 2015

American Journal of Transplantation

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“…This practice is also associated with a reduced risk of primary graft dysfunction after lung transplantation (18). It is common for transplant surgeons to reduce the volume of the allograft during transplant surgery, and lobar transplantation is an accepted transplant procedure (19)(20)(21)(22). Together these data suggest that it may be reasonable to perform lobar transplantation or surgically downsize substantially oversized allografts for shorter transplant candidates and expect that outcomes would be no worse, and perhaps better, than a strategy that includes an extended waiting period until a small allograft is available.…”

Section: Discussionmentioning

confidence: 99%

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Sell¹,

Bacchetta²,

Goldfarb

et al. 2016

Am J Respir Crit Care Med

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Rationale: Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates.Objectives: To examine the relationship between lung transplant candidate height and waiting list outcomes.Methods: We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year. Measurements and Main Results:The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (,162 cm) and 202.0 per 100 person-years among candidates of average stature (170-176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29-39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24-96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10-85%) higher rate of respiratory failure while awaiting lung transplantation.Conclusions: Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height.

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“…(b) Radiografía de tórax postoperatoria en la que se aprecia ligero desplazamiento cardiaco hacia la derecha sin repercusión hemodinámica. 76 Todavía no se disponen de resultados a largo plazo, pero pese al escaso número de pacientes trasplantados con esta técnica y su aparente buena evolución postoperatoria, podría convertirse en una técnica habitual para paliar el escaso número de donantes y su utilización en pacientes con medidas torácicas pequeñas. 77 En 2007 se publica un estudio retrospectivo que demostraba que solo 5 de los 514 pacientes infantiles (menores de 18 años) con FQ en lista de espera de TP tendrían una mejora en la supervivencia después del trasplante, por lo tanto, el aparente beneficio del TP en pacientes con FQ se ponía en entredicho.…”

Section: Intermediario (Figura 4)unclassified

El trasplante pulmonar en la fibrosis quística y la influencia de la circulación extracorpórea

Deu

Romero

Román

et al. 2018

Archivos de Bronconeumología

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Lobar transplantation, split lung transplantation and peripheral segmental resection – reliable procedures for downsizing donor lungs

Abstract: Size reduced lung transplantation, including split lung transplantation, lobar transplantation and peripheral segmental resection, is a reliable procedure providing equal results compared to standard lung transplantation.

Cited by 94 publications

References 7 publications

Right and Left Inverted Lobar Lung Transplantation

Right and Left Inverted Lobar Lung Transplantation

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

El trasplante pulmonar en la fibrosis quística y la influencia de la circulación extracorpórea

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