title: Lobar lung transplantation--is it comparable with standard lung transplantation?
abstract: Lobar lung transplantation is used mainly for urgent small recipients who are less likely to obtain size matched lungs in due time. Only limited numbers have been published, and we herewith report the largest series of lobar-LuTX. We analyzed our LuTX database from 1/2001 to 12/2012 and compared the outcome of lobar-LuTX recipients with those receiving standard LuTX. Seven hundred and seventy-eighty LuTX (group 1) were performed either in standard technique by implanting the whole lungs (n = 539) or with downsizing by wedge resection of the right middle lobe and/or the left lingula (n = 239). One hundred and thirty-eight LuTX were performed in lobar technique (group 2) to overcome more pronounced size discrepancies. Patients in group 1 had a different spectrum of diagnoses and were less frequently bridged to LuTX (P < 0.001). Intubation time, ICU stay, and hospital stay were shorter in group 1 (P < 0.001). One-year survival was 84.8% vs. 65.1%, and 5-years survival 69.9% vs. 54.9% (P < 0.001). In multivariate analyzes, procedure, diagnosis, and pre-operative bridging were shown to be significant prognostic factors in survival. Early postoperative outcome in Lobar LuTX was significantly inferior to standard LuTX recipients. However, survival rates of successfully dismissed patients were comparable with standard LuTX (P = 0.168); thereby, Lobar-LuTX remains an important option in the management of urgent small recipients.
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Alexis
authors.initials: A
authors.lastname: Slama
authors.forename: Bahil
authors.initials: B
authors.lastname: Ghanim
authors.forename: Thomas
authors.initials: T
authors.lastname: Klikovits
authors.forename: Axel
authors.initials: A
authors.lastname: Scheed
authors.forename: Mir A
authors.initials: MA
authors.lastname: Hoda
authors.forename: Konrad
authors.initials: K
authors.lastname: Hoetzenecker
authors.forename: Peter
authors.initials: P
authors.lastname: Jaksch
authors.forename: Jose
authors.initials: J
authors.lastname: Matilla
authors.forename: Sharokh
authors.initials: S
authors.lastname: Taghavi
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
authors.forename: Clemens
authors.initials: C
authors.lastname: Aigner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D049628:Body Size; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: extracorporeal support; lobar; lobar lung transplantation; lung transplantation; size-mismatch