Size-reduced lung transplantation: an advanced operative strategy to alleviate donor organ shortage

The increasing need for donor lungs, especially for small and pediatric recipients, has not been matched by an adequate supply. This disparity has stimulated the development of new operative techniques, which allow downsizing of larger lungs for use in smaller recipients, thus potentially expanding the donor pool. This approach has recently gained more widespread use, especially for highly urgent recipients; however, is still not considered a standard procedure.

All primary size-reduced lung transplants performed from January 2001 to December 2003 were retrospectively reviewed. Downsizing was achieved by either split-lung transplantation, lobar transplantation, or by means of a peripheral wedge resection. Waiting list time, perioperative complications, and outcomes of those patients were compared to patients undergoing primary standard single or double lung transplantation during the observation period.

Among 163 primary lung transplantations 51 (31.3%) were size-reduced procedures. Size reduction was achieved by lobar transplantation (n = 18), split-lung transplantation (n = 2), or peripheral segmental resection (n = 31). There was a slightly decreased waiting time among the size-reduced group (74 +/- 72 vs 98 +/- 90 days, P = .13). No statistically significant difference between the size-reduced and the standard lung transplantation group was evident with regard to the rate of bronchial healing problems (n = 3/9; P = .62) or the rate of revision due to postoperative bleeding (n = 6/15; P = .77). No other major thoracic surgical complications were observed. The 3-month survival rate was 86.3% in the size-reduced 92.0% in the standard group (P = .09).

Size-reduced lung transplantations, including split-lung transplantation, lobar transplantation, and peripheral segmental resection, may be considered reliable procedures that provide results comparable to standard lung transplantation. It allows the use of oversized grafts for small and pediatric recipients and the use of single lobes if localized pathologies exist, thus enlarging the donor pool and potentially helping to reduce waiting times and waiting list mortality.