Double-lung transplant for advanced chronic obstructive lung disease

Area of Science:

• Cardiovascular and Respiratory System Sciences
• Transplantation Medicine
• Surgical Innovation

Background:

• Pulmonary fibrosis and advanced obstructive/infective lung diseases necessitate innovative treatment strategies.
• Current lung transplant options may not optimally address all end-stage lung disease scenarios.
• The limitations of combined heart-lung transplantation warrant exploration of alternative approaches.

Purpose of the Study:

• To evaluate the efficacy and safety of an en bloc, double-lung transplant procedure.
• To compare the double-lung transplant approach with combined heart-lung transplantation.
• To assess the suitability of double-lung transplantation for patients with adequate right heart function.

Main Methods:

• Development and application of an en bloc, double-lung transplant technique.
• Performance of six double-lung transplants for end-stage emphysema.
• One unsuccessful transplant for primary pulmonary hypertension.

Main Results:

• All six recipients of double-lung transplants for emphysema are alive and well 5 to 15 months post-procedure.
• The double-lung transplant approach allows recipients to retain their native heart, avoiding cardiac transplant complications.
• Donor hearts are available for separate recipients, increasing lung transplant availability.

Conclusions:

• The en bloc, double-lung transplant is a viable and effective procedure for select patients with advanced lung disease.
• This technique offers advantages over combined heart-lung transplantation, particularly when right heart function is preserved.
• Addressing donor airway ischemia is crucial for improving outcomes in double-lung transplantation.