LIVING-RELATED DONOR LOBECTOMY FOR BILATERAL LOBAR TRANSPLANTATION INPATIENTS WITH CYSTIC-FIBROSIS

Donor lobectomy has been performed in 14 patients enabling 7 recipient s with cystic fibrosis to undergo bilateral living-related lobar pulmo nary transplantation. Donors included 11 parents, 2 brothers, and 1 un cle. Donor mean age was 43 years (range 24 to 55 years). Their mean he ight and weight was 170 cm (range, 169 to 180 cm) and 72.4 kg (range, 55 to 90 kg), respectively, compared with 161 cm (range, 140 to 175 cm ) and 42.4 kg (range, 27 to 55 kg), respectively, in the recipient gro up. Donor pulmonary evaluation consisted of a history and physical exa mination, chest roentgenogram and computed tomographic scan, spirometr y with arterial blood gas measurement, echocardiography, and perfusion scanning. From each pair of donors, one was selected for right lower lobectomy and the other for left lower lobectomy. Standard lobectomy t echniques were modified to facilitate implantation and optimize preser vation of the donor lobes. On the right side, the middle lobe was remo ved and discarded in the first three donors to provide an adequate cuf f of pulmonary artery and bronchus for implantation. With increased ex perience, this has proved not to joe necessary. There have been no dea ths and no long-term complications in the donor group. Prolonged posto perative air leaks occurred in the 3 patients who underwent right lowe r and middle lobectomies. All donors have been able to resume their pr evious lifestyles. Living-related donor lobectomy provides an alternat ive to cadaveric organs in select patients in need of pulmonary transp lantation.