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J Thorac Cardiovasc Surg 1996;112:1284-1291
© 1996 Mosby, Inc.
CARDIAC AND PULMONARY REPLACEMENT |
From the Division of Cardiothoracic Surgery, University of Southern California School of Medicine, Los Angeles, Calif.
Received for publication May 6, 1996 Revisions requested June 10, 1996; revisions received July 15, 1996 Accepted for publication July 17, 1996. Address for reprints: Vaughn A. Starnes, MD, Professor and Chief, Division of Cardiothoracic Surgery, School of Medicine, 1510 San Pablo St., Suite 415, Los Angeles, CA 90033-4612.
Abstract
Objective: Living-donor lobar lung transplantation offers an alternative for patients with a life expectancy of less than a few months. We report on our intermediate results with respect to recipient survival, complications, pulmonary function, and hemodynamic reserve.
Methods: Thirty-eight living-donor lobar lung transplants were performed in 27 adult and 10 pediatric patients for cystic fibrosis (32), pulmonary hypertension (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 follow-up of 14 months. Predominant cause of death was infection, consistent with the large percentage of patients with cystic fibrosis in our population. The overall incidence of rejection was 0.07 episodes/patient-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; pressures and pulmonary vascular resistances were within normal ranges. Bronchiolitis obliterans was definitively diagnosed in three patients. Among the 76 donors, complications in the postoperative period included postpericardiotomy syndrome (three), atrial fibrillation (one), and surgical reexploration (three).
Conclusions: We believe that these data support an expanded role for living-donor lobar lung transplantation. Our intermediate data are encouraging with respect to the functional outcome and survival of these critically ill patients, who would have died without this option.
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