LOBAR TRANSPLANTATION - INDICATIONS, TECHNIQUE, AND OUTCOME

Lobar transplantation represents a therapeutic option for children and some adults with severe endstage pulmonary disease. Six patients incl uding two neonates, three children, and one adult underwent lobar tran splantation. Ages ranged from 17 days to 21 years. Transplant procedur es were unilateral in the neonates and two of the children and bilater al in the child and adult who had cystic fibrosis. The donor lobes wer e from cadavers in the two neonates and living related donors in the c hildren and the adult. Unilateral grafts involved use of the right upp er lobe in the 12-year-old patient with bronchopulmonary dysplasia; ri ght middle lobe with a ventricular septal defect repair in the 4-year- old patient with Eisenmenger's syndrome, left upper lobe in the 28-day -old patient with primary pulmonary hypertension, and the right upper and middle lobes in the 17-day-old patient with diaphragmatic hernia. Bilateral lobar transplantations were performed with the right lower a nd left lower lobes in the two patients with cystic fibrosis (aged 13 and 21 years). The two neonates underwent emergency transplantation wi th the use of extracorporeal membrane oxygenation as a bridge. Periope rative survival was 83 %, with only the 4-year-old patient with ventri cular septal defect/Eisenmenger's syndrome dying early. No airway comp lications were observed. The unilateral grafts received most of the bl ood flow as shown by perfusion scanning (range 74% to 99%). Living rel ated donor complications included prolonged air leaks (>6 days) in two patients. In urgent situations, such as an infant requiring extracorp oreal membrane oxygenation, and in the existing milieu of donor shorta ge, lobar transplantation Giving related or cadaveric) is a surgically feasible procedure and can provide a donor source in the limited time frame of these clinical situations. Bilateral lobe transplantation ma y be a viable option for patients with cystic fibrosis and life-threat ening respiratory decompensation.