A decade of living lobar lung transplantation: recipient outcomes.
OBJECTIVE
Living lobar lung transplantation was developed as a procedure for patients considered too ill to await cadaveric transplantation.


METHODS
One hundred twenty-eight living lobar lung transplantations were performed in 123 patients between 1993 and 2003. Eighty-four patients were adults (age, 27 +/- 7.7 years), and 39 were pediatric patients (age, 13.9 +/- 2.9 years).


RESULTS
The primary indication for transplantation was cystic fibrosis (84%). At the time of transplantation, 67.5% of patients were hospitalized, and 17.9% were intubated. One-, 3-, and 5-year actuarial survival among living lobar recipients was 70%, 54%, and 45%, respectively. There was no difference in actuarial survival between adult and pediatric living lobar recipients (P =.65). There were 63 deaths among living lobar recipients, with infection being the predominant cause (53.4%), followed by obliterative bronchiolitis (12.7%) and primary graft dysfunction (7.9%). The overall incidence of acute rejection was 0.8 episodes per patient. Seventy-eight percent of rejection episodes were unilateral. Age, sex, indication, donor relationship, preoperative hospitalization status, use of preoperative steroids, and HLA-A, HLA-B, and HLA-DR typing did not influence survival. However, patients on ventilators preoperatively had significantly worse outcomes (odds ratio, 3.06, P =.03; Kaplan-Meier P =.002), and those undergoing retransplantation had an increased risk of death (odds ratio, 2.50).


CONCLUSIONS
These results support the continued use of living lobar lung transplantation in patients deemed unable to await a cadaveric transplantation. We consider patients undergoing retransplantations and intubated patients to be at significantly high risk because of the poor outcomes in these populations.
Starnes
Vaughn A
VA
University of Southern California Keck School of Medicine and Childrens Hospital Los Angeles, 90033, USA.
Bowdish
Michael E
ME
Woo
Marlyn S
MS
Barbers
Richard G
RG
Schenkel
Felicia A
FA
Horn
Monica V
MV
Pessotto
Renzo
R
Sievers
Eric M
EM
Baker
Craig J
CJ
Cohen
Robbin G
RG
Bremner
Ross M
RM
Wells
Winfield J
WJ
Barr
Mark L
ML
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002140:California; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011336:Probability; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018434:Sickness Impact Profile; D015996:Survival Rate; D013997:Time Factors