3D-multidetector CT angiography in the evaluation of potential donors for living donor lung transplantation.
BACKGROUND
In living donor lung transplant, donor lobectomies from 2 donors provide right and left lower lobes for transplantation. In the past, routine evaluation of pulmonary anatomy was not performed preoperatively. Intraoperatively, surgeons were often forced to sacrifice the lingular artery or right middle lobe segmental artery to obtain an adequate arterial cuff for safe reimplantation. This study was performed to evaluate the utility of preoperative 3D-multidetector CT angiography (3D-MDCTA) as a noninvasive method of assessing pulmonary arteries to improve donor selection and surgical planning for living lung donors.


METHODS
Five potential lung donors for 2 recipients were included in the study. CT scanning with 4 channel multidetector-row CT was performed, using a modified pulmonary embolism protocol. Post-processing was performed using volume rendering techniques on a commercially available workstation.


RESULTS
3D-MDCT demonstrated that there are a number of variations in pulmonary arterial anatomy and that ideal anatomy was seldom encountered. Comparison of different donors determined which lower lobes were most favorable for transplantation. Surgery confirmed the accuracy of 3D-MDCTA. There were no pulmonary arterial complications, and no vessels were sacrificed.


CONCLUSIONS
Safely explanting lower lobes from living donors for lung transplantation poses challenges not encountered in harvesting cadaveric donors or performing lobectomies for malignancy. 3D-MDCTA of pulmonary arteries can noninvasively delineate the often-complex pulmonary anatomy, which may assist in donor selection as well as reduce donor intraoperative and postoperative vascular complications.
Duong
Phuong-Anh T
PA
Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Ferson
Peter F
PF
Fuhrman
Carl R
CR
McCurry
Kenneth R
KR
Lacomis
Joan M
JM
D000328:Adult; D000792:Angiography / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D019520:Living Donors; D008168:Lung / Q000033:anatomy & histology / Q000098:blood supply / Q000000981:diagnostic imaging*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000637:transplantation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D014283:Triiodobenzoic Acids / Q000008:administration & dosage
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol