Unilateral lung transplantation using right and left upper lobes: an experimental study

Area of Science:

• Thoracic Surgery
• Organ Transplantation
• Pulmonary Medicine

Background:

• Significant organ donor shortage in Japan necessitates innovative transplantation strategies.
• Extended-criteria donor lungs, often rejected, contain upper lobes with potential for transplantation.
• Current limitations exist in using these upper lobes due to size constraints for size-matched recipients.

Purpose of the Study:

• To investigate the feasibility of unilateral lung transplantation using combined right and left upper lobes.
• To assess the technical and functional viability of this downsized lung graft approach.

Main Methods:

• Harvested swine heart-lung blocks to create a left lung graft from right and left upper lobes.
• Transplanted the prepared graft into the left thoracic space of recipient swine (Group A, n=5).
• Evaluated graft function for 6 hours, comparing with a control group (Group B, n=5) undergoing standard left lung transplantation.

Main Results:

• Mean partial pressure of oxygen post-reperfusion was 507 mm Hg (Group A) vs. 463 mm Hg (Group B).
• Mean pulmonary arterial pressure was 30.3 mm Hg (Group A) vs. 27.5 mm Hg (Group B).
• Mean airway pressure showed comparable values: 6.4 mm Hg (Group A) vs. 6.2 mm Hg (Group B).

Conclusions:

• Unilateral left lung transplantation using right and left upper lobes is technically and functionally feasible.
• This method offers a viable solution for size-matched recipients.
• The technique allows for the utilization of rejected donor lungs with intact upper lobes, expanding donor pool options.