Perioperative complications after living donor lobectomy

Objective: Clinical lung transplantation has been limited by availability o f suitable cadaveric donor lungs. Living donor lobectomy provides right and left lower lobes from a pair of living donors for each recipient. We revie wed our experience with living donor lobectomy from July 1994 to February 2 000. Methods: Sixty-two donor lobectomies were performed. The hospital and outpa tient records of these 62 donors were retrospectively analyzed to examine t he incidence of perioperative complications. Results: Twenty-four (38.7%) of 62 donors had no perioperative complication s and had a median length of hospital stay of 5.0 days. Thirty-eight (61.3% ) of 62 donors had postoperative complications. Twelve major complications occurred in 10 patients and included pleural effusions necessitating draina ge (n = 4), bronchial stump fistulas (n = 3), bilobectomy (n = 1), hemorrha ge necessitating red cell transfusion (n = 1), phrenic nerve injury (n = 1) , atrial flutter ultimately necessitating electrophysiologic ablation (n = 1), and bronchial stricture necessitating dilatation (n = 1). These 38 dono rs had 55 minor complications including persistent air leaks (n = 9), peric arditis (n = 9), pneumonia (n = 8), arrhythmia (n = 7), transient hypotensi on necessitating fluid resuscitation (n = 4), atelectasis (n = 3), ileus (n = 3), subcutaneous emphysema (n = 3), urinary tract infections (n = 2), lo culated pleural effusions (n = 2), transfusion (n = 2), Clostridium diffici le colitis (n = 1), puncture of a saline breast implant (n = 1), and severe contact dermatitis secondary to adhesive tape (n = 1). There were no posto perative deaths and only 1 donor required surgical re-exploration. Conclusions: Living donor lobectomy can be performed with low mortality and remains an important alternative for potential recipients unable to wait f or cadaveric lung allografts. However, morbidity is high and must be consid ered when potential living donors are being counseled.