title: Long-term outcomes of bilateral lobar lung transplantation.
abstract: OBJECTIVE
  Lobar lung transplantation is an option that provides the possibility of transplanting an urgent listed recipient of small size with a size-mismatched donor lung by surgically reducing the size of the donor lung. We report our short- and long-term results with bilateral lobar lung transplantation (BLLT) and compare it with the long-term outcomes of our cohort.
  
  
  METHODS
  Retrospective analyses of 75 lung transplant recipients who received downsized lungs with a special focus on 23 recipients with BLLT performed since January 2000. Postoperative surgical complications, lung function tests, late complications and survival were analyzed. The decision to perform lobar transplantation was considered during allocation and finally decided prior to implantation.
  
  
  RESULTS
  Cystic fibrosis was the most common indication (43.5%) followed by pulmonary fibrosis (35%). Median age at transplantation was 41 (range 13-66) years. Fifteen were females. Nineteen of the transplantations (83%) were done with extracorporeal membrane oxygenation (ECMO) support; 3 of them were already on ECMO prior to transplantation. There was no 30-day or in-hospital mortality. No bronchial complications occurred. The most common early complication was haematothorax (39%), which required surgical intervention. The rate of postoperative atrial arrhythmias was 30%. Forced expiratory volumes in 1 s (% predicted) at 1 and 2 years were 76 ± 23 and 76 ± 22, respectively (mean ± standard deviation). By 2-year follow-up, bronchiolitis obliterans syndrome was documented in 3 patients with a median follow-up of 1457 days. Overall survivals at 1 and 5 years were 82 ± 8 and 64 ± 11%, respectively and were comparable with those of 219 other recipients who received bilateral lung transplantation during the same period (log rank test, P = 0.56).
  
  
  CONCLUSIONS
  This study demonstrates that BLLT has short- and long-term outcomes comparable with those of standard bilateral lung transplantation. The limitation of lung transplantation due to size-mismatch, particularly in smaller recipients, could be overcome by utilizing lobar lung transplantation.
authors.affiliation: Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland. ilhan.inci@usz.ch
authors.forename: Ilhan
authors.initials: I
authors.lastname: Inci
authors.forename: Mace M
authors.initials: MM
authors.lastname: Schuurmans
authors.forename: Peter
authors.initials: P
authors.lastname: Kestenholz
authors.forename: Didier
authors.initials: D
authors.lastname: Schneiter
authors.forename: Sven
authors.initials: S
authors.lastname: Hillinger
authors.forename: Isabelle
authors.initials: I
authors.lastname: Opitz
authors.forename: Annette
authors.initials: A
authors.lastname: Boehler
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: Lobar transplantation; Lung transplantation; Size-reduced lung transplantation