A Stanzi1, H Decaluwe1, W Coosemans1, P De Leyn1, P Nafteux1, H Van Veer1, L Dupont2, G M Verleden2, D Van Raemdonck3. 1. Department of Thoracic Surgery, University Hospitals Gasthuisberg, Leuven, Belgium. 2. Department of Pneumology, University Hospitals Gasthuisberg, Leuven, Belgium. 3. Department of Thoracic Surgery, University Hospitals Gasthuisberg, Leuven, Belgium; Laboratory for Experimental Thoracic Surgery, Katholieke Universiteit, Leuven, Belgium. Electronic address: dirk.vanraemdonck@uzleuven.be.
Abstract
BACKGROUND: Small-sized patients with cystic fibrosis usually face long waiting times for a suitable lung donor. Reduced-size lung transplantation (LTx) was promoted to shorten waiting times. We compared donor and recipient characteristics and outcome in lobar ([L]) versus full-size ([FS]) lung recipients. METHODS: Between July 1, 1991, and February 28, 2011, 535 isolated LTx were performed, including 74 in cystic fibrosis patients (8 L, 66 FS). Patients were followed up until September 2012. RESULTS: [L] recipients were younger, smaller, and lighter. Sex, waiting times, and donor data (age, sex, height, weight, PaO2/FiO2, and ventilation time) were comparable. Cardiopulmonary bypass was used more often in [L]; cold ischemia was comparable for first lung but longer in [L] for second lung; implantation times were comparable. In-hospital mortality rate was 0% in [L] versus 3% in [FS]. Both intensive care unit and hospital stay were longer in [L]. Grade 3 primary graft dysfunction was more pronounced in [L] at T0 and at T48. FEV1 increased significantly in both groups from preoperative value. Bronchiolitis obliterans syndrome was absent in [L] and diagnosed in 18 patients in [FS], accounting for 6 of 15 late deaths. All [L] are still alive. No differences in survival were found between the groups. CONCLUSIONS: Although hindered by a higher incidence of primary graft dysfunction, L-LTx is a viable option with excellent survival and pulmonary function comparable to FS-LTx.
BACKGROUND: Small-sized patients with cystic fibrosis usually face long waiting times for a suitable lung donor. Reduced-size lung transplantation (LTx) was promoted to shorten waiting times. We compared donor and recipient characteristics and outcome in lobar ([L]) versus full-size ([FS]) lung recipients. METHODS: Between July 1, 1991, and February 28, 2011, 535 isolated LTx were performed, including 74 in cystic fibrosispatients (8 L, 66 FS). Patients were followed up until September 2012. RESULTS: [L] recipients were younger, smaller, and lighter. Sex, waiting times, and donor data (age, sex, height, weight, PaO2/FiO2, and ventilation time) were comparable. Cardiopulmonary bypass was used more often in [L]; cold ischemia was comparable for first lung but longer in [L] for second lung; implantation times were comparable. In-hospital mortality rate was 0% in [L] versus 3% in [FS]. Both intensive care unit and hospital stay were longer in [L]. Grade 3 primary graft dysfunction was more pronounced in [L] at T0 and at T48. FEV1 increased significantly in both groups from preoperative value. Bronchiolitis obliterans syndrome was absent in [L] and diagnosed in 18 patients in [FS], accounting for 6 of 15 late deaths. All [L] are still alive. No differences in survival were found between the groups. CONCLUSIONS: Although hindered by a higher incidence of primary graft dysfunction, L-LTx is a viable option with excellent survival and pulmonary function comparable to FS-LTx.
Authors: Anton Sabashnikov; Mohamed Zeriouh; Prashant N Mohite; Nikhil P Patil; Diana García-Sáez; Bastian Schmack; Simona Soresi; Pascal M Dohmen; Aron-Frederik Popov; Alexander Weymann; André R Simon; Fabio De Robertis Journal: Med Sci Monit Basic Res Date: 2016-07-13