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Chida M, Inoue T, Araki O, Maeda S. Left-to-right rotated single lung transplant. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 62:6650626. [PMID: 35894664 DOI: 10.1093/ejcts/ezac369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/03/2022] [Indexed: 11/12/2022]
Abstract
We successfully performed left-to-right rotated single lung transplants in 2 patients. For this procedure, the left pulmonary artery of the donor undergoes a U-shaped turn with A3 at the bottom to anastomose with the recipient's right pulmonary artery in front of the bronchus. It is extremely important to avoid kinking the pulmonary artery at the site of the U-shaped turn.
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Affiliation(s)
- Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Japan
| | - Takashi Inoue
- Department of General Thoracic Surgery, Dokkyo Medical University, Japan
| | - Osamu Araki
- Department of General Thoracic Surgery, Dokkyo Medical University, Japan
| | - Sumiko Maeda
- Department of General Thoracic Surgery, Dokkyo Medical University, Japan
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Right lung transplantation with a left-to-right inverted anastomosis in a rat model. JTCVS OPEN 2022; 10:429-439. [PMID: 36004231 PMCID: PMC9390618 DOI: 10.1016/j.xjon.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022]
Abstract
Objective Right lung transplantation in rats has been attempted occasionally, but the technical complexity makes it challenging to apply routinely. Additionally, basic research on inverted lobar lung transplantation is scarce because of the lack of a cost-effective experimental model. We first reported right lung transplantation in a rat model using left-to-right inverted anastomosis to imitate the principle of clinically inverted lung transplantation. Methods Right lung transplantation was performed in 10 consecutive rats. By using a 3-cuff technique, the left lung of the donor rat was implanted into the right thoracic cavity of the recipient rat. The rat lung graft was rotated 180° along the vertical axis to achieve anatomic matching of right hilar structures. Another 10 consecutive rats had received orthotopic left lung transplantation as a control. Results All lung transplantation procedures were technically successful without intraoperative failure. One rat (10%) died of full pulmonary atelectasis after right lung transplantation, whereas all rats survived after left lung transplantation. No significant difference was observed in heart-lung block retrieval (8.6 ± 0.8 vs 8.4 ± 0.9 minutes), cuff preparation (8.3 ± 0.9 vs 8.7 ± 0.9 minutes), or total procedure time (58.2 ± 2.6 vs 56.6 ± 2.1 minutes) between the right lung transplantation and standard left lung transplantation groups (P > .05), although the cold ischemia time (14.2 ± 0.9 vs 25.5 ± 1.7 minutes) and warm ischemia time (19.8 ± 1.5 vs 13.7 ± 1.8 minutes) were different (P < .001). Conclusions Right lung transplantation with a left-to-right inverted anastomosis in a rat model is technically easy to master, expeditious, and reproducible. It can potentially imitate the principle of clinically inverted lung transplantation and become an alternative to standard left lung transplantation.
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Right-to-left inverted single lung transplantation. JTCVS Tech 2020; 4:395-397. [PMID: 34318084 PMCID: PMC8307873 DOI: 10.1016/j.xjtc.2020.08.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022] Open
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Date H. Commentary: How to avoid vascular kinking in implanting a contralateral lung graft. JTCVS Tech 2020; 4:399-400. [PMID: 34318086 PMCID: PMC8306569 DOI: 10.1016/j.xjtc.2020.08.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yamamoto H, Miyoshi K, Otani S, Kurosaki T, Sugimoto S, Yamane M, Toyooka S, Kobayashi M, Oto T. Right single lung transplantation using an inverted left donor lung: interposition of pericardial conduit for pulmonary venous anastomosis - a case report. BMC Pulm Med 2020; 20:46. [PMID: 32075616 PMCID: PMC7031900 DOI: 10.1186/s12890-020-1075-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 02/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung transplantation (LTx) is still limited by the shortage of suitable donor lungs. Developing flexible surgical procedures can help to increase the chances of LTx by unfolding recipient-to-donor matching options based on the pre-existing organ allocation concept. We report a case in which a successful left-to-right inverted LTx was completed using the interposition of a pericardial conduit for pulmonary venous anastomosis. CASE PRESENTATION A left lung graft was offered to a 59-year-old male who had idiopathic pulmonary fibrosis with predominant damage in the right lung. He had been prescribed bed rest with constant oxygen inhalation through an oxymizer pendant and had been on the waiting list for 20 months. Considering the condition of the patient (LAS 34.3) and the scarcity of domestic organ offers, the patient was highly likely to be incapable of tolerating any additional waiting time for another donor organ if he was unable to accept the presently reported offer of a left lung. Eventually, we decided to transplant the left donor lung into the right thorax of the recipient. Because of the anterior-posterior position gap of the hilar structures, the cuff lengths of the pulmonary veins had to be adjusted. The patient did not develop any anastomotic complications after the transplantation. CONCLUSIONS A left-to-right inverted LTx is technically feasible using an autologous pericardial conduit for pulmonary venous anastomosis in selected cases. This technique provides the potential benefit of resolving challenging situations in which surgeons must deal with a patient's urgency and the logistical limitations of organ allocation.
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Affiliation(s)
| | - Kentaroh Miyoshi
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shinji Otani
- Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takeshi Kurosaki
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | | | - Masaomi Yamane
- Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | | | | | - Takahiro Oto
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan.
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Chen-Yoshikawa TF, Tanaka S, Yamada Y, Yutaka Y, Nakajima D, Ohsumi A, Hamaji M, Menju T, Date H. Intermediate outcomes of right-to-left inverted living-donor lobar lung transplantation. Eur J Cardiothorac Surg 2019; 56:1046-1053. [DOI: 10.1093/ejcts/ezz244] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/07/2019] [Accepted: 08/10/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractOBJECTIVESOwing to the severe donor shortage in Japan, living-donor lobar lung transplantation (LDLLT) remains a valuable option. As only lobes are implanted in LDLLT, grafts may be too small, especially for adult recipients. To overcome this obstacle, we developed right-to-left inverted LDLLT. In this procedure, the right lower lobe, which is 25% bigger than the left lower lobe, is used as the left-side graft instead of the left lower lobe. This study aimed to investigate the characteristics and intermediate outcomes of right-to-left inverted LDLLT.METHODSSince the first right-to-left inverted LDLLT performed in 2014, 48 LDLLTs have been performed in our institution, of which 15 were right-to-left inverted LDLLTs. We reviewed their characteristics and intermediate outcomes.RESULTSThe reasons for choosing an inverted procedure instead of the standard LDLLT were small-for-size graft in 11 cases and anatomical variation of donor vessels in 4 cases. The first patient underwent left single LDLLT using a right lower lobe graft, and the following 14 patients underwent bilateral LDLLT using 2 right lower lobe grafts. A native upper lobe-sparing procedure was additionally applied in 2 patients. No complications occurred in the bronchial and vascular anastomoses. No operative mortality occurred, and all the patients were discharged home after LDLLT. The 3-year survival was 92.3%, with a median follow-up time of 40 months. The donor postoperative course was uneventful, and all the donors returned to their regular routine postoperatively.CONCLUSIONRight-to-left inverted LDLLT is a safe and useful option with encouraging intermediate outcome.
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Affiliation(s)
| | - Satona Tanaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Chen F, Miyamoto E, Takemoto M, Minakata K, Yamada T, Sato M, Aoyama A, Date H. Right and left inverted lobar lung transplantation. Am J Transplant 2015; 15:1716-21. [PMID: 25846520 DOI: 10.1111/ajt.13148] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/14/2014] [Accepted: 12/07/2014] [Indexed: 01/25/2023]
Abstract
Adult recipients frequently withdraw from living-donor lobar lung transplantation because of the small size of donor grafts. The right lower lobe is 120% larger than the left lower lobe. We developed a novel surgical technique in which an inverted right lower lobe graft can be transplanted into the left thorax. The first patient was a 43-year-old woman with end-stage idiopathic interstitial pneumonia. Her husband was the only eligible donor for living-donor lobar lung transplantation. His right lower lobe was estimated to provide 45% of the recipient's predicted forced vital capacity, which would provide the borderline function required for living-donor lobar lung transplantation. Since lung perfusion scintigraphy of the recipient showed a right-to-left ratio of 64:36, transplanting the right lower lobe graft into the left thorax and sparing the native right lung was considered the only treatment option. We simulated this procedure using three-dimensional models produced by a three-dimensional printer. In living-donor lobar lung transplantation, all anastomoses were performed smoothly as planned preoperatively. Because of the initial success, this procedure was performed successfully in two additional patients. This procedure enables larger grafts to be transplanted, potentially solving critical size matching problems in living-donor lobar lung transplantation.
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Affiliation(s)
- F Chen
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - E Miyamoto
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - M Takemoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - K Minakata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - M Sato
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - A Aoyama
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - H Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Chen JY, Zheng MF, Jing ZH, Wang YG, Zhu QK, Chen R. Case Report: A Left Donor Lung Implanted in the Recipient’s Right Thorax for the Therapy of Pulmonary Fibrosis. Transplant Proc 2006; 38:1535-7. [PMID: 16797352 DOI: 10.1016/j.transproceed.2006.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Indexed: 11/30/2022]
Abstract
A 68-year patient suffering from pulmonary fibrosis underwent single lung transplantation on April 4, 2005. Because the ipsilateral donor lung was severely damaged, we had to implant the contralateral lung--the left lung--to the right thorax, and finally this patient recovered.
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Affiliation(s)
- J Y Chen
- Department of General Thorax, No. 5 Hospital of WuXi, JiangSu Province, China.
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