Adult living-donor lobar lung transplant using a small-for-size graft

This study was designed to examine the outcomes of adult living-donor lobar lung transplants (LDLLTs) using small-for-size grafts.

A calculated graft forced vital capacity of <50% of the predicted forced vital capacity of the recipient was considered to indicate a small-for-size graft. Adult recipients (≥18 years) who underwent LDLLTs between 2008 and 2022 were included in this study.

We performed 80 adult LDLLTs, using small-for-size grafts in 15 patients and non-small grafts in 65 patients. Grade 3 primary graft dysfunction developed within 72 h after the transplant in 3 patients (20%) in the small group and in 3 patients (4.6%) in the non-small group (P = 0.0763). The 1- and 5-year survival rates were 86.7% and 69.3% in the small group and 93.8% and 77.1% in the non-small group (P = 0.742). In the small group, the native lungs were spared in 8 patients, whereas 2 lobar grafts were implanted with non-spared native lungs in the other 7 patients. The 1- and 5-year survival rates were significantly better in the spared group (both 100%) than in the non-spared group (71.4% and 23.8%; P = 0.0375). The spared group showed a significantly higher median percent forced vital capacity after the transplant than the non-spared group (68.5% vs 44.9%; P = 0.0027).

Although the use of small-for-size grafts was associated with a higher rate of severe primary graft dysfunction, no differences were found in survival rates. When the graft is small, the native lung should be partially spared if possible.