title: Surgical Strategy for Lung Transplantation in Adults With Small Chests: Lobar Transplant Versus a Pediatric Donor.
abstract: BACKGROUND
  Adult lung transplant recipients with small chests have traditionally received lungs from pediatric donors, placing an additional strain on the already restricted pediatric donor pool. Performing lobar lung transplantation (LLT) can circumvent issues with donor-recipient size mismatch; however, LLT imparts additional risks. Here, we review our experience using LLT and standard lung transplantation using a pediatric donor (PDLT) for adults with small chests.
  
  
  METHODS
  We retrospectively reviewed consecutive patients with end-stage lung disease and a height of 65 inches or less who underwent LLT (n = 15) or PDLT (n = 15) between 2006 and 2012 at our institution, a high-volume lung transplant center.
  
  
  RESULTS
  Lobar lung transplantation recipients were older (54 ± 10 vs 48 ± 8 years) and had higher pulmonary pressure (57 ± 11 vs 52 ± 27 mmHg) and higher lung allocation scores (70 ± 9 vs 51 ± 8) than PDLT recipients (all P < 0.05). Mean waiting time was 62 days for PDLT and 9 days for LLT. Postoperatively, the incidence of severe primary graft dysfunction and the incidence of acute renal insufficiency were higher, and the mean intensive care unit stay was longer in the LLT group, but the incidence of bronchial anastomotic complications was higher in the PDLT group because of significant size discrepancy in the main bronchus (P < 0.05). Interestingly, long-term functional outcomes and survival rates were similar between the groups.
  
  
  CONCLUSIONS
  Both LLT and PDLT are viable surgical options for adult patients with small chests. Because of the potential impact on posttransplant outcomes, the technical complexity of transplantation, decisions regarding the best surgical approach should be made by experienced surgeons.
authors.affiliation: 1 Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.2 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Balakrishnan
authors.initials: B
authors.lastname: Mahesh
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.forename: David D
authors.initials: DD
authors.lastname: Odell
authors.forename: Awori J
authors.initials: AJ
authors.lastname: Hayanga
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Morrell
authors.forename: Maria M
authors.initials: MM
authors.lastname: Crespo
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pilewski
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Johnson
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000714:Anastomosis, Surgical; D049628:Body Size; D001980:Bronchi / Q000601:surgery; D002648:Child; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D008168:Lung / Q000033:anatomy & histology / Q000601:surgery; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome