title: Techniques and results of lobar lung transplantations.
abstract: OBJECTIVE
  We report our experience of lobar lung transplantations (LLTs) in patients with small thoracic volume.
  
  
  METHODS
  Since 1988, 50 LLTs were done for cystic fibrosis (n=35), fibrosis (n=7), bronchiectasis (n=3), emphysema (n=3) and lymphangiomyomatosis (n=2). There were 44 females and 6 males (mean age 31±13 years, mean size 155±5.5 cm and mean predicted total lung capacity (TLC) 4463±598 ml). Mean ratio between donor and recipient-predicted TLC was 1.65±0.26. Six patients were listed in high emergency, 2 of them on ECMO as a bridge to transplantation. Forty middle/lower right lobe with left lower LLT, four bilateral lower LLT and six split left lung LLT were performed through a clamshell incision (n=12) or a bilateral antero-lateral thoracotomy (n=38), with epidural analgesia in 17 cases. Thirty-two patients were transplanted under circulatory support (CPB n=16, veno-arterial ECMO n=16). In 11 cases, the right venous anastomosis was enlarged by a pericardial cuff. Ischaemic time was 4.4±1.2 h for the first lobe and 6.1±1.3 h for the second.
  
  
  RESULTS
  Median mechanical ventilation weaning time was 10.5 (1-136) days. Four patients were extubated in the operating room. Ten patients needed ECMO for primary graft dysfunction. In-hospital mortality was 28% related to sepsis (n=6), PGD (n=3), haemorrhage (n=2), broncho-vascular fistula (n=1), and multiorgan failure (n=2). Eight patients required endoscopic treatments for airway complications. Mean best FEV1 was 72±16% of the theoretical value. The actuarial 3-year and 5-year survival rates were 60 and 46%, respectively.
  
  
  CONCLUSIONS
  LLTs are a reliable solution and can be performed with satisfactory functional results and survival rates.
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Mitilian
authors.forename: Edouard
authors.initials: E
authors.lastname: Sage
authors.forename: Philippe
authors.initials: P
authors.lastname: Puyo
authors.forename: Pierre
authors.initials: P
authors.lastname: Bonnette
authors.forename: François
authors.initials: F
authors.lastname: Parquin
authors.forename: Marc
authors.initials: M
authors.lastname: Stern
authors.forename: Marc
authors.initials: M
authors.lastname: Fischler
authors.forename: Alain
authors.initials: A
authors.lastname: Chapelier
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome; D055815:Young Adult
keywords: Donor–recipient size mismatch; EMCO; Lobar lung transplantation; Thoracic epidural analgesia