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Lobar transplantation. Indications, technique, and outcome
V A Starnes1, M L Barr, R G Cohen
1Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033.
The Journal of Thoracic and Cardiovascular Surgery
|September 1, 1994
Summary
Lobar transplantation is a feasible surgical option for pediatric and adult end-stage lung disease, offering a vital donor source in urgent situations. This procedure demonstrated an 83% perioperative survival rate with no airway complications observed.
Area of Science:
- Cardiothoracic Surgery
- Pediatric Pulmonology
- Transplantation Medicine
Background:
- Severe end-stage pulmonary disease necessitates advanced treatment options for pediatric and adult patients.
- Donor lung shortage poses a significant challenge in providing timely treatment.
- Lobar lung transplantation offers a potential solution by utilizing lobes from living related or cadaveric donors.
Purpose of the Study:
- To evaluate the surgical feasibility and outcomes of lobar lung transplantation in neonates, children, and adults.
- To assess the efficacy of lobar transplantation as a bridge to survival in critical cases.
- To explore the role of bilateral lobar transplantation for specific conditions like cystic fibrosis.
Main Methods:
- Retrospective analysis of six patients (two neonates, three children, one adult) who underwent lobar transplantation.
- Procedures included unilateral and bilateral lobar grafts from cadaveric and living related donors.
- Extracorporeal membrane oxygenation (ECMO) was used as a bridge in neonates.
Main Results:
- Perioperative survival rate was 83%, with one early mortality in a patient with Eisenmenger's syndrome.
- No airway complications were observed post-transplantation.
- Unilateral grafts demonstrated excellent blood flow (74%–99%), and living related donors experienced prolonged air leaks in two cases.
Conclusions:
- Lobar transplantation is a surgically feasible procedure, especially in urgent pediatric cases and donor-limited situations.
- Bilateral lobar transplantation is a viable option for patients with cystic fibrosis and severe respiratory compromise.
- This approach provides a timely donor source, improving survival prospects for critically ill patients.