Living-donor lobar lung transplantation experience: intermediate results.
OBJECTIVE
Living-donor lobar lung transplantation offers an alternative for patients with a life expectancy of less than a few months. We report on our intermediate results with respect to recipient survival, complications, pulmonary function, and hemodynamic reserve.


METHODS
Thirty-eight living-donor lobar lung transplants were performed in 27 adult and 10 pediatric patients for cystic fibrosis (32), pulmonary hypertension (two), pulmonary fibrosis (one), viral bronchiolitis (one), bronchopulmonary dysplasia (one), and posttransplantation obliterative bronchiolitis (one). Seventy-six donors underwent donor lobectomies.


RESULTS
There were 14 deaths among the 37 patients, with an average follow-up of 14 months. Predominant cause of death was infection, consistent with the large percentage of patients with cystic fibrosis in our population. The overall incidence of rejection was 0.07 episodes/patient-month, representing 0.8 episodes/patient. Postoperative pulmonary function testing generally showed a steady improvement that plateaued by postoperative months 9 to 12. Fourteen patients who were followed up for at least 1 year underwent right heart catheterization; pressures and pulmonary vascular resistances were within normal ranges. Bronchiolitis obliterans was definitively diagnosed in three patients. Among the 76 donors, complications in the postoperative period included postpericardiotomy syndrome (three), atrial fibrillation (one), and surgical reexploration (three).


CONCLUSIONS
We believe that these data support an expanded role for living-donor lobar lung transplantation. Our intermediate data are encouraging with respect to the functional outcome and survival of these critically ill patients, who would have died without this option.
Division of Cardiothoracic Surgery, University of Southern California School of Medicine, Los Angeles 90033-4612, USA.
V A
VA
Starnes
M L
ML
Barr
R G
RG
Cohen
J A
JA
Hagen
W J
WJ
Wells
M V
MV
Horn
F A
FA
Schenkel
D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000601:surgery; D002648:Child; D016638:Critical Illness; D003550:Cystic Fibrosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000503:physiopathology / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D016896:Treatment Outcome