Deceased-donor lobar lung transplant: A successful strategy for small-sized recipients

Jose Luis Campo-Canaveral De La Cruz, Ben Dunne, Philippe Lemaitre, Mindaugas Rackauskas, Jiri Pozniak, Yui Watanabe, Andrea Mariscal, Jonathan Yeung, Kazuhiro Yasufuku, Andrew Pierre, Marc de Perrot, Thomas K. Waddell, Marcelo Cypel, Shaf Keshavjee, Laura Donahoe

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Objectives: Lobar lung transplantation (LLTx) from deceased donors is a potential solution for donor–recipient size mismatch for small sized recipients. We reviewed our institutional experience to compare outcomes after LLTx to standard lung transplantation (LTx). Methods: We retrospectively reviewed transplants in our institution from January 2000 to December 2017. LLTx early- and long-term outcomes were compared with LTx. Additional analysis of outcomes was performed after dividing the cohort into 2 eras (era 1, 2000-2012; era 2, 2013-2017). Results: Among the entire cohort (1665), 75 were LLTx (4.5%). Compared with LTx, LLTx were more frequently bridged to transplant with extracorporeal life support or mechanical ventilation and were transplanted in a rapidly deteriorating status (respectively, 20% vs 4.4%, P = .001; 22.7% vs 7.9, P < .001; and 41.3% vs 26.5%, P = .013). LLTx had longer intensive care unit and hospital lengths of stay (respectively, median 17 vs 4 days, and 45 vs 23, both P < .001), and greater 30-day mortality (13.3% vs 4.3%, P = .001) and 90-day mortality (17.3% vs 7.2%, P = .003). In era 2, despite a significantly greater 30-day mortality (10.8% vs 2.8%, P = .026), there was no significant difference in 90-day mortality between LLTx and LTx (13.5% vs 5.1%, P = .070). Overall survival at 1, 3, and 5 years was not significantly different between LLTx and LTx (73.2% vs 84.4%, 56.9% vs 68.4% and 50.4% vs 55.8, P = .088). Conclusions: Although LLTx is a high-risk procedure, both mid- and long-term survival are comparable with LTx in all cohorts in the modern era. LLTx therefore represents a valuable surgical option for small-sized recipients.

Original languageEnglish
Pages (from-to)1674-1685
Number of pages12
JournalJournal of Thoracic and Cardiovascular Surgery
Volume161
Issue number5
DOIs
Publication statusPublished - 2021 May
Externally publishedYes

Keywords

  • lobar lung transplant
  • lung transplant
  • size matching

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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