Education Corner – Lobar Lung Transplantation

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Background

  • A single lobe can be taken from the donor lung for transplantation into smaller, adult patients.
  • Lobar lung transplantation (LLT) was first reported in 1994 (Bisson, et al.).
  • Currently, in limited practice and championed at the University of Pittsburgh Medical Center in the U.S.
  • Lung allocation score (LAS) system does not take size matching into account, LLT can help maximize the donor pool for patients for whom mortality is particularly high (25%), while they await transplant (Shigemura, et al.):
    • Smaller patients
    • Restrictive lung disease patients

Procedure

  • Lung fissures are evaluated carefully onsite and suitability discussed at time of visualization during procurement.
  • Lower lobe is preferable unless contraindicated (e.g. trauma, consolidation, etc.).
  • Lobectomy is performed on the back table pre-transplant.
  • Bronchial stump is typically reinforced with viable donor pericardium.

Risks of LLT

  • Longer post-operative recovery with special post-transplant care pathway considerations.
  • Modestly longer warm ischemic times due to lobectomy time requirements.
  • Bronchial stump dehiscence and implications for technical surgical considerations and post-surgical management.

Lessons Learned

  • LLT is a viable option for patients with smaller chest cavities and restrictive lung disease.
  • Due to LLT-specific risks, potential recipient and donor identification must be selective.
  • Protocolized and multidisciplinary approach are key to successful outcomes which are competitive with normal anatomic lung transplantation.

Taken from a webinar presentation by Dr. Jonathan D’Cunha, MD, PhD, FACS (UPMC Presbyterian). A special thanks to Dr. D’Cunha for his contributions to this inservice.

References:

Bisson, A. et al (1994).    Bilateral pulmonary lobe transplantation: left lower and right middle and lower lobes. Ann Thorac Surg. 1994; 57:  219-221.

Shigemura N., et al (2013). Lobar lung transplantation: a relevant surgical option in the current era of lung allocation score.  Ann Thorac Surg.  213; 96(2): 451-456.

 

A special thanks to Elizabeth Spencer from Elizabeth Katherine Communications LLC for her contributions to this issue.

Editor: Hedi Aguiar RN, MSN, Director of Programs and Communications, The Alliance, haguiar@odt-alliance.org.
This Education Corner is available for downloadThe Alliance grants permission for the distribution and reproduction of this educational communication.

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