Long-term outcomes of cadaveric lobar lung transplantation: helping to maximize resources.
BACKGROUND
Cadaveric lobar lung transplantation (CLLTx) represents a potential opportunity to address the bias against smaller recipients, especially children, on transplant waiting lists. The widespread use of CLLTx is hindered by the paucity of outcome data with respect to early complications and long-term lung function and survival.


METHODS
We looked at the long-term outcomes in 9 patients undergoing CLLTx since May 2003, including early surgical complications, pulmonary function tests, and survival. Patients were analyzed by whether the decision to perform CLLTx was elective (made at the time of listing) or emergent (surgical decision).


RESULTS
The incidence of early complications in the entire group was low, with the most common being atrial arrhythmias and prolonged thoracostomy tube. Lung function at 1 and 2 years (mean forced expiratory volume in 1 second % predicted +/- standard deviation of 73 +/- 18 and 60.5 +/- 27, respectively) was equivalent to living lobar transplant results. Overall survival was similar to 199 patients who received conventional cadaveric LTx during the same period.


CONCLUSIONS
This study suggests that CLLTx has a low complication rate with acceptable lung function and long-term survival, especially in cases where consideration has been given to CLLTx at the time of listing. CLLTx warrants consideration more often for patients of smaller physique to improve their chance of receiving LTx.
Keating
Dominic T
DT
Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Prahran, Melbourne, Victoria, Australia. d.keating@alfred.org.au <d.keating@alfred.org.au>
Marasco
Silvana F
SF
Negri
Justin
J
Esmore
Donald
D
Burton
Jacquie H
JH
Griffiths
Anne P
AP
Buckland
Mark
M
Westall
Glen P
GP
Williams
Trevor J
TJ
Snell
Gregory I
GI
D000293:Adolescent; D000328:Adult; D000368:Aged; D049628:Body Size; D002102:Cadaver; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000502:physiology*; D016040:Lung Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D040841:Resource Allocation / Q000379:methods*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult