Right and Left Inverted Lobar Lung Transplantation

Abstract

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.

Inverted Lobes Have Satisfactory Functions Compared With Noninverted Lobes in Lung Transplantation

“…The details of the operative technique of inverted LDLLT were previously reported [6,7]. Briefly, after left pneumonectomy, the inverted right lower lobe graft was placed in the recipient left cavity.…”

“…Because only 2 lobes are implanted, size mismatch often becomes a problem, and 2 lobes may be too small, especially for adult recipients. To overcome the size-mismatch issue, we developed two new techniques in LDLLT: native lung-sparing LDLLT and inverted LDLLT [5][6][7][8].…”

“…We recently reported the satisfactory surgical and shortterm outcomes of the inverted LDLLT technique [6,7]. However, the functions of inverted grafts are uncertain.…”

Living-related lung transplantation

“…We have developed two transplant procedures, native upper lobe sparing LDLLT (26) and right-left inverted LDLLT (27).…”

Pulmonary Function and Exercise Capacity in Patients With Flat Chests After Lung Transplantation

“…(Ann Thorac Surg 2017;104:1695-701) Ó 2017 by The Society of Thoracic Surgeons L iving-donor lobar lung transplantation (LDLLT) is an established alternative for patients who cannot wait for cadaveric lung transplantation [1][2][3][4]. Unlike cadaveric lung transplantation, there can be large size discrepancies between the donor and recipient because of the limited population of potential LDLLT donors [5].…”