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Living lobar lung transplantation.
Michael E Bowdish1, Mark L Barr
1Department of Cardiothoracic Surgery, University of Southern California and Childrens Hospital Los Angeles, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA.
Respiratory Care Clinics of North America
|December 9, 2004
Summary
Living lobar lung transplantation offers a life-saving option for critically ill patients, with no reported donor mortality in the series. However, careful donor selection and risk assessment are crucial, especially for high-risk recipients.
Area of Science:
- Medicine
- Transplantation Surgery
- Thoracic Surgery
Background:
- Living lobar lung transplantation is a viable alternative for patients awaiting cadaveric organs.
- Donor safety and long-term outcomes are paramount for program sustainability.
- Ethical considerations and donor risk-benefit analysis are critical.
Purpose of the Study:
- To evaluate the safety and outcomes of living lobar lung transplantation.
- To identify risk factors for perioperative and long-term mortality in living lung donors and recipients.
- To inform clinical decision-making regarding donor selection and recipient suitability.
Main Methods:
- Retrospective analysis of a series of living lobar lung transplantations.
- Comparison of perioperative risks with standard lung resections.
- Identification of patient subgroups with increased mortality risk.
Main Results:
- No perioperative or long-term mortality in the donor cohort.
- Perioperative risks for donors are comparable to standard lung resections.
- Patients requiring preoperative mechanical ventilation or retransplantation face significantly higher mortality risks.
Conclusions:
- Living lobar lung transplantation is a life-saving procedure for carefully selected, critically ill patients.
- While donor risks are low, a 0.5-1% mortality risk should be communicated.
- Further long-term data are needed, and cautious application in high-risk subgroups is recommended.