Living Donor Lobar Lung Transplantation (LDLTx): A Safe and Effective Therapy

John C Wain, Jr., Cameron D Wright, Dean M Donahue, James S. Allan, Henning A. Gaissert, Michael Lanuti, Daniel P Ryan, Leo C Ginns, Douglas J Mathisen
Massachusetts General Hospital, Boston, MA

Objective:
Assess the outcome of LDLTx for both donors and recipients
Design:
Prospective, non-randomized longitudinal study.
Setting:
Academic tertiary care medical center
Patients:
Fifteen candidates (8 female, 5 male) selected for LDLTx due to clinical deterioration. Diagnoses: cystic fibrosis (11), lymphangioleiomyomatosis (2), pulmonary fibrosis (2). Thirty healthy adults (18 female, 12 male) selected as donors. Seven donors unrelated; 9 were siblings, 6 were parents, 8 were first degree relatives.
Interventions:
Sequential bilateral transplantation of right and left lower lobes in each recipient. In 13 recipients, heterotopic transplantation of the lobes to the hila using cardiopulmonary bypass (CPB). Orthotopic right lower lobe implantation, preserving native upper and middle lobes, performed in 2 without CPB. Ischemic time: 150 + 25 min right lobe, 125 + 15 min left lobe. Induction immunosuppression: OKT3 (10) or rabbit ATG (5). Maintenance therapy was cyclosporine-azathioprine-steroid.
Outcome Measures:
Donor, recipient survival; length of stay (LOS); complications. Incidence of acute rejection (AR) and obliterative bronchiolitis (OB) in recipients.
Results:
Donor survival was 100%. Donor LOS was 3.5 + 0.75 days. Complications: pleural effusion (4), arrhythmia (2), pneumothorax (1). No prolonged airleaks or BPF. Recipient LOS 73 + 34 days. Operative mortality was 2/15 (POD 14, POD 24). Kaplan-Meier actuarial survival: 86% (1 month), 80% (1 year), 75% (3 years). AR occurred 0.5 episodes/pt/year. OB was identified in 4/13 surviving > 3 months.
Conclusions:
LDLTx is safe for both donors and recipients. Long term survival for LDLTx recipients is similar to cadaver recipients. The incidence of AR/OB is low.

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