EXPERIENCE WITH LIVING-DONOR LOBAR TRANSPLANTATION FOR INDICATIONS OTHER THAN CYSTIC-FIBROSIS

Citation
Va. Starnes et al., EXPERIENCE WITH LIVING-DONOR LOBAR TRANSPLANTATION FOR INDICATIONS OTHER THAN CYSTIC-FIBROSIS, Journal of thoracic and cardiovascular surgery, 114(6), 1997, pp. 917-921
Citations number
6
ISSN journal
00225223
Volume
114
Issue
6
Year of publication
1997
Pages
917 - 921
Database
ISI
SICI code
0022-5223(1997)114:6<917:EWLLTF>2.0.ZU;2-N
Abstract
Objective: Since development of a living donor bilateral lobar transpl antation protocol for patients with cystic fibrosis, our indications h ave expanded to include recipients with other diagnoses. Methods: We r eport on our experience in eight patients with primary pulmonary hyper tension, postchemotherapy pulmonary fibrosis, bronchopulmonary dysplas ia, idiopathic pulmonary fibrosis, and obliterative bronchiolitis. The average age of the eight patients was 19.1 years (range 9 to 40). The mean preoperative carbon dioxide tension for the four patients who di d not have primary pulmonary hypertension nas 92 mm Hg (range 64 to 12 0 mm Hg), and the two patients with pulmonary fibrosis were intubated (one on high-frequency jet ventilation). Each recipient received a rig ht lower lobe (n = 7) or middle lobe (n = 1) and a left lower lobe (n = 8) from a total of 16 donors representing various combinations of th e recipient's family (n = 15) and an unrelated friend (n = 1). Results : With an average follow-up of 1 year the overall survival is 75%. For the five patients followed up for at least 1 year, mean forced vital capacity was 80.6%, forced expiratory volume in 1 second was 75.6%, mi d-forced expiratory flow nas 64%, and diffusing lung capacity correcte d for alveolar volume was 73% of predicted. For those patients with pr imary pulmonary hypertension, preoperative hemodynamics revealed mean pressures as follows: blood pressure 84.8 mm Hg, right atrial pressure 7.8 mm Hg, pulmonary artery pressure 71.3 mm Hg, pulmonary capillary wedge pressure 9.5 mm Hg, cardiac index 2.9 L/min per square meter, an d pulmonary vascular resistance index 22.8 Wood units. Postoperative h emodynamics revealed a mean blood pressure of 84.3 mm Hg, right atrial pressure of 2.7 mm Hg, pulmonary artery pressure of 16 mm Hg, pulmona ry capillary wedge pressure of 7.3 mm Hg, cardiac index of 4.2 L/min p er square meter, and pulmonary vascular resistance index of 1.9 Wood u nits. Conclusions: Early results of living-donor bilateral lobar trans plantation for diseases other than cystic fibrosis have resulted in sa tisfactory survival and pulmonary function. Additionally, patients wit h severe primary pulmonary hypertension have had dramatic normalizatio n of their hemodynamics despite the limited amount of lung tissue tran splanted. We believe that the data from this small cohort experience c ompares favorably with our larger series with cystic fibrosis and supp orts an expanded role for living-donor lobar transplantation in patien ts with alternate indications.