Techniques and results of lobar lung transplantations

Abstract

Objectives: We report our experience of lobar lung transplantations (LLTs) in patients with small thoracic volume. Methods: Since 1988, 50 LLTs were done for cystic fibrosis (n = 35), fibrosis (n = 7), bronchiectasis (n = 3), emphysema (n = 3) and lymphangiomyomatosis (n = 2). There were 44 females and 6 males (mean age 31 ± 13 years, mean size 155 ± 5.5 cm and mean predicted total lung capacity (TLC) 4463 ± 598 ml). Mean ratio between donor and recipient-predicted TLC was 1.65 ± 0.26. Six patients were listed in high emergency, 2 of them on ECMO as a bridge to transplantation. Forty middle/lower right lobe with left lower LLT, four bilateral lower LLT and six split left lung LLT were performed through a clamshell incision (n = 12) or a bilateral antero-lateral thoracotomy (n = 38), with epidural analgesia in 17 cases. Thirty-two patients were transplanted under circulatory support (CPB n = 16, veno-arterial ECMO n = 16). In 11 cases, the right venous anastomosis was enlarged by a pericardial cuff. Ischaemic time was 4.4 ± 1.2 h for the first lobe and 6.1 ± 1.3 h for the second. Results: Median mechanical ventilation weaning time was 10.5 (1-136) days. Four patients were extubated in the operating room. Ten patients needed ECMO for primary graft dysfunction. In-hospital mortality was 28% related to sepsis (n = 6), PGD (n = 3), haemorrhage (n = 2), broncho-vascular fistula (n = 1), and multiorgan failure (n = 2). Eight patients required endoscopic treatments for airway complications. Mean best FEV1 was 72 ± 16% of the theoretical value. The actuarial 3-year and 5-year survival rates were 60 and 46%, respectively. Conclusions: LLTs are a reliable solution and can be performed with satisfactory functional results and survival rates. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.