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  • Print publication year: 2011
  • Online publication date: September 2011

Chapter 25 - Long-term management and outcomes

from Section 4 - Liver

Summary

Bilateral living donor lung transplantation in which two healthy donors donate their right or left lower lobes is an alternative to cadaveric transplantation. The most common procedure involves a right lower lobectomy from a larger donor and a left lower lobectomy from a smaller donor. Potential donors should be competent, willing to donate free of coercion, medically and psychosocially suitable, and fully informed of risks, benefits, and alternative treatment available to the recipient. All recipients should fulfill the criteria for conventional cadaveric transplantation. Due to possible serious complications in the donor lobectomy, living donor lobar lung transplantation (LDLLT) should be reserved for critically ill patients who are unlikely to survive the long wait for cadaveric lungs. Postoperative immunosuppression usually consists of triple-drug therapy with cyclosporine (CyA), azathioprine (AZA) and corticosteroids without induction. LDLLT may be associated with a lower incidence of Bronchiolitis obliterans syndrome (BOS), especially in pediatric patients.

Further reading

BaconBR, O’GradyJG, di BisceglieAM, LakeJR. Comprehensive Clinical Hepatology. Philadelphia, PA: Elsevier, 2005.
BentenD, StauferK, SterneckM. Orthotopic liver transplantation and what to do during follow-up: recommendations for the practitioner. Nat Clin Pract Gastroenterol Hepatol 2009; 6: 23–36.
ILTS/AASLDTransplant Course: Long-Term Outcomes of Adult and Pediatric Liver Transplantation. Liver Transpl 2009; 15 (S2), 1–94.