title: Long-term improvement in pulmonary function after living donor lobar lung transplantation.
abstract: BACKGROUND
  As an alternative to cadaveric transplantation, living donor lobar lung transplantation (LDLLT) has been applied in critical patients with end-stage pulmonary disease because of the mismatch between the supply and demand of lungs for transplantation. However, it is unclear whether two pulmonary lobes can provide adequate long-term pulmonary function and satisfactory clinical outcome in recipients.
  
  
  METHODS
  Between October 1998 and September 2004, 28 females and 3 males, including 5 children, underwent LDLLT at Okayama University Hospital. Their mean age was 31.8 years, and the mean observation period was 53.8 months. One patient who underwent single-lung transplantation and another who died peri-operatively were excluded from further analyses.
  
  
  RESULTS
  The most common indication for transplantation was pulmonary arterial hypertension (32.3%). The overall survival rate was 93.6%. Seven recipients (22.6%) developed bronchiolitis obliterans syndrome after LDLLT. The mean percent predicted forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) improved between 12 and 24 months after transplantation (71.8 +/- 12.9% and 65.8 +/- 17.2% at 12 months vs 77.4 +/- 16.6% and 72.8 +/- 14.6% at 24 months; p < 0.005 and p < 0.05, respectively). The actual recipient FVC ultimately reached 123.0% of the estimated graft FVC of two donor lobes (calculated based on the donor FVC and number of segments implanted) at 36 months after LDLLT.
  
  
  CONCLUSIONS
  Although LDLLT may be associated with the limitation of size mismatch, it holds promise for providing well-functioning pulmonary lobar grafts to critically ill patients with poor life expectancy.
authors.affiliation: Department of Cancer and Thoracic Surgery (Surgery II), Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Yamane
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.forename: Megumi
authors.initials: M
authors.lastname: Okazaki
authors.forename: Shinichi
authors.initials: S
authors.lastname: Toyooka
authors.forename: Motoi
authors.initials: M
authors.lastname: Aoe
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Sano
mesh_terms: D000293:Adolescent; D000328:Adult; D001784:Blood Gas Analysis; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D019520:Living Donors; D008168:Lung / Q000502:physiology*; D008171:Lung Diseases / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology; D016896:Treatment Outcome