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
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.