LIVING-DONOR LOBAR LUNG TRANSPLANTATION EXPERIENCE - INTERMEDIATE RESULTS

Objective: Living-donor lobar lung transplantation offers an alternati ve for patients with a life expectancy of less than a few months. We r eport on our intermediate results with respect to recipient survival, complications, pulmonary function, and hemodynamic reserve. Methods: T hirty-eight living-donor lobar lung transplants were performed in 27 a dult and 10 pediatric patients for cystic fibrosis (32), pulmonary hyp ertension (two), pulmonary fibrosis (one), viral bronchiolitis (one), bronchopulmonary dysplasia (one), and posttransplantation obliterative bronchiolitis (one). Seventy-six donors underwent donor lobectomies. Results: There were 14 deaths among the 37 patients, with an average f ollow-up of 14 months. Predominant cause of death,vas infection, consi stent with the large percentage of patients with cystic fibrosis in ou r population. The overall incidence of rejection was 0.07 episodes/pat ient-month, representing 0.8 episodes/patient. Postoperative pulmonary function testing generally showed a steady improvement that plateaued by postoperative months 9 to 12. Fourteen patients who were followed up for at least 1 year underwent right heart catheterization; pressure s and pulmonary vascular resistances were within normal ranges. Bronch iolitis obliterans was definitively diagnosed in three patients. Among the 76 donors, complications in the postoperative period included pos tpericardiotomy syndrome (three), atrial fibrillation (one), and surgi cal reexploration (three). Conclusions: We believe that these data sup port an expanded role for living-donor lobar lung transplantation. Our intermediate data are encouraging with respect to the functional outc ome and survival of these critically ill patients, who would have died without this option.