Living-donor lobar lung transplantation

Area of Science:

• Thoracic Surgery
• Transplantation Immunology
• Pulmonary Medicine

Background:

• Living-donor lobar lung transplantation (LDLLT) addresses critical shortages of brain-dead donors for lung transplants.
• It is crucial to ensure voluntary donation without coercion.
• LDLLT involves implanting lobes from two healthy donors into recipients requiring cardiopulmonary support.

Purpose of the Study:

• To evaluate the efficacy and outcomes of living-donor lobar lung transplantation (LDLLT).
• To explore alternative surgical techniques when ideal donor matching is unavailable.
• To compare LDLLT outcomes with cadaveric lung transplantation (CLT).

Main Methods:

• Standard LDLLT procedure using right and left lower lobes from two donors.
• Functional and anatomical size matching using pulmonary function tests and 3D CT volumetry.
• Consideration of alternative procedures like single lobe, segmental, or inverted lobar transplants.

Main Results:

• LDLLT is applicable to diverse lung diseases in adult and pediatric patients.
• Postoperative pulmonary function is equivalent to CLT, with potential immunological advantages.
• Long-term outcomes are similar or superior to CLT, with a reported 10-year survival rate of 71.6% in one series.
• Living donors experienced no long-term lifestyle impact, but potential serious morbidity necessitates careful patient selection.

Conclusions:

• LDLLT is a viable and effective alternative to CLT, especially for critically ill patients.
• Careful donor selection and size matching are essential for successful LDLLT.
• The procedure offers comparable or better long-term survival rates and immunological benefits.