- 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
- 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.
- 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.
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, firstname.lastname@example.org.
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