Lobar Lung Transplantation

Abstract

Lobar lung transplant is a technique that allows for large-sized donor lungs to be implanted into small-sized adult and pediatric recipients. Often, these recipients have longer waiting list times due to a shortage of appropriately sized donors, with the potential for increased waiting list mortality. Lobar lung transplant involves implanting a single lobe from each lung instead of the usual full-lung implant, thus ameliorating the size difference between donor and recipient. The first important step in this procedure involves proper donor-recipient size-matching, using calculation of total lung capacity using the bronchopulmonary segments to choose the appropriate lobes for the recipient. The preferred lobes to use are the lower lobes (or right lower lobe and right middle lobe, depending on sizing) as they are usually larger lobes and have a larger vascular bed. The surgery should ideally be done at experienced centers with high volume thoracic surgery where surgeons are very familiar with the pulmonary anatomy. Once the lungs are split, careful dissection is performed in order to ensure that the cuffs on the vein, artery and bronchus of the lobe to be used are of adequate length and undamaged during the dissection. The implantation must be performed on cardio-pulmonary support (preferably venoarterial extracorporeal membrane oxygenation) in order protect the lobes during the periods of reperfusion.