Split lung transplantation with intraoperative extracorporeal membrane oxygenation (ECMO) support

Area of Science:

• Cardiothoracic Surgery
• Transplantation Medicine
• Pulmonary Medicine

Background:

• Split lung transplantation, first described in 1997, optimizes donor lung utilization.
• The technique allows a single donor lung to be divided for bilateral transplantation in smaller recipients.
• Similar techniques for splitting the right lung were developed in 2001.

Purpose of the Study:

• To describe the technique of pulmonary bipartitioning (split lung transplantation).
• To highlight the efficient use of donor lungs through this surgical approach.
• To present the specific technique developed at the Medical University of Vienna.

Main Methods:

• Donor lung procurement follows standard lung transplantation procedures.
• The donor lung is surgically separated into upper and lower lobes at the interlobar fissure before implantation.
• The lower lobe is implanted in the left hemithorax; the upper lobe is rotated and grafted into the right hilus.
• Extracorporeal membrane oxygenation (ECMO) is used for intraoperative hemodynamic stability and to prevent reperfusion injury.

Main Results:

• Split lung transplantation enables the use of one donor lung for two recipients.
• The described technique facilitates bilateral transplantation using a single donor organ.
• ECMO ensures graft protection and patient stability during the procedure.

Conclusions:

• Pulmonary bipartitioning represents the most efficient method for utilizing donor lungs.
• The described surgical technique, including lobe implantation and ECMO use, is effective for split lung transplantation.
• This approach enhances organ utilization in lung transplantation programs.