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

Chapter 15 - Living donor lobar lung transplantation

from Section 3 - Lung

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.

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Further reading

BarrML, BelghitiJ, VillamilFG, et al. A report of the Vancouver Forum on the care of the live organ donor. Lung, liver, pancreas, and intestine data and medical guidelines. Transplantation 2006; 81:1372–87.
DateH, AoeM, SanoY, et al. Improved survival after living-donor lobar lung transplantation. J Thorac Cardiovasc Surg 2004; 128: 933–40.
DateH, KusanoKF, MatsubaraH, et al. Living-donor lobar lung transplantation for pulmonary arterial hypertension after failure of epoprostenol therapy. J Am Coll Cardiol 2007; 50: 523–7.
ShojiT, BandoT, FujinagaT, DateH. Living-donor single-lobe lung transplant in a 6-year-old girl after 7-month mechanical ventilator support. J Thorac Cardiovasc Surg 2010; 139: e112–13.
StarnesVA, BowdishME, WooMS, et al. A decade of living lobar lung transplantation. Recipient outcomes. J Thorac Cardiovasc Surg 2004; 127: 114–22.
SweetSC. Pediatric living donor lobar lung transplantation. Pediatr Transplantation 2006; 10: 861–8.