A new treatment strategy for advanced idiopathic interstitial pneumonia: living-donor lobar lung transplantation.
BACKGROUND
Among patients awaiting cadaveric lung transplantation, patients with idiopathic interstitial pneumonia (IIP) have been demonstrated to have the highest mortality rate. Contraindications to cadaveric lung transplantation include current high-dose systemic corticosteroid therapy because it may increase airway complications and various types of infection.


OBJECTIVE
To analyze the effect of living-donor lobar lung transplantation (LDLLT) for patients with advanced IIP including those receiving high-dose systemic corticosteroids.


METHODS
Retrospective analysis.


METHODS
Okayama University Hospital and Okayama Medical Center.


METHODS
We report on the first nine patients (seven female and two male; age range, 13 to 55 years) with advanced IIP receiving LDLLT. All nine patients had a very limited life expectancy, and eight patients were dependent on systemic corticosteroid therapy as high as 50 mg/d of prednisone. LDLLT was performed under cardiopulmonary bypass using two lower lobes donated by two healthy relatives.


RESULTS
There were no airway complications in the 18 bronchial anastomoses. There was one early death (11%) due to severe acute rejection. Eight patients (89%) are currently alive with a follow-up period of 10 to 48 months. Their vital capacity reached 2.03 +/- 0.20 L (mean +/- SEM), 71.4% of predicted at 1 year. All 18 donors have returned to their previous lifestyles. Excised lungs were pathologically diagnosed as usual interstitial pneumonia (UIP) in six cases and fibrotic nonspecific interstitial pneumonia (NSIP) in three cases.


CONCLUSIONS
These early follow-up data support the option of LDLLT in patients with advanced IIP, including UIP and fibrotic NSIP, who would die soon otherwise. Current high-dose systemic corticosteroid therapy is not a contraindication in LDLLT.
Date
Hiroshi
H
Department of Cancer and Thoracic Surgery (Surgery II), Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-Cho, Okayama 700-8558, Japan. hdate@nigeka2.hospital.okayama-u.ac.jp
Tanimoto
Yasushi
Y
Goto
Keiji
K
Yamadori
Ichiro
I
Aoe
Motoi
M
Sano
Yoshifumi
Y
Shimizu
Nobuyoshi
N
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019520:Living Donors; D017563:Lung Diseases, Interstitial / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones