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Abstract
Lung transplantation (LT) is the only viable option for a selected group of patients with end stage pulmonary diseases. During the recent years satisfactory results in terms of long-term survival and quality of life have been achieved with improvements in surgical technique, immunosuppression and perioperative management. Since the beginning, the airway anastomosis has been considered crucial and significant efforts have been made to understand the healing process. A number of experimental studies allowed improving the surgical technique by modifying the technique of suturing, the anastomotic protection and type and dose of immunosuppression, reducing the risk of airway complications. Furthermore, a huge progress has been made in the management of such complications. Early diagnosis of bronchial complications and their prompt and correct management are crucial to achieve long-term survival.
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Affiliation(s)
- Marco Anile
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Daniele Diso
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Erino Angelo Rendina
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Federico Venuta
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
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Mohite PN, Popov AF, Yacoub MH, Simon AR. Live related donor lobar lung transplantation recipients surviving well over a decade: still an option in times of advanced donor management. J Cardiothorac Surg 2013; 8:37. [PMID: 23497549 PMCID: PMC3599940 DOI: 10.1186/1749-8090-8-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/04/2013] [Indexed: 12/04/2022] Open
Abstract
As waiting lists for lung transplantation are ever increasing, the number of organ donors is not able to keep pace with it. Living donor lobar lung transplantation is a source of organs which could be lifesaving in end-stage lung disease patients who cannot wait for cadaveric organs due to deteriorating lung function and clinical condition. Two young women with end stage cystic fibrosis received lobes from their relatives and an altruistic friend. They are surviving for more than 12 and 14 years with good lung functions.
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Affiliation(s)
- Prashant N Mohite
- Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Hill End Road, Harefield, UB9 6JH, Middlesex, UK.
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3
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Cystic fibrosis and the thoracic surgeon. Eur J Cardiothorac Surg 2010; 39:716-25. [PMID: 20822917 DOI: 10.1016/j.ejcts.2010.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/19/2010] [Accepted: 07/21/2010] [Indexed: 11/21/2022] Open
Abstract
Indications for thoracic surgery in patients with cystic fibrosis (CF) are principally represented by pleural diseases including pneumothorax, pleural effusion, and empyema and by parenchymal lung diseases including bronchiectasis, hemoptysis, and pulmonary abscess. Moreover, lung transplantation has proved a viable therapeutic option for progressive respiratory failure due to end-stage CF. Main surgical experiences in this setting are reviewed and discussed.
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Yoon W, Ryu JM, Lee MY, Moon YJ, Lee SH, Park JH, Yun SP, Jang MW, Park SS, Han HJ. 64-channel multi-detector row CT angiographic evaluation of the micropigs for potential living donor lung transplantation. J Vet Sci 2010; 11:185-9. [PMID: 20706024 PMCID: PMC2924478 DOI: 10.4142/jvs.2010.11.3.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Micropigs are the most likely source animals for xenotransplantation. However, an appropriate method for evaluating the lung of micropigs had not been established. Therefore, this study was performed to evaluate the feasibility of 64-channel multi-detector row computed tomography (MDCT) to measure the diameter of the pulmonary arteries and the lung volume in micropigs. The mean diameters of the trachea, and left and right bronchi were 1.6 ± 0.17, 1.18 ± 0.14, and 1.1 ± 0.11 cm, respectively. The mean diameters of the main, right, and left pulmonary arteries were 1.38 ± 0.09, 1.07 ± 0.26, and 0.98 ± 0.13 cm and the diameters of right, left, and common inferior pulmonary veins were 0.97 ± 0.20, 0.76 ± 0.20, and 1.99 ± 0.26 cm, respectively. The mean lung volume was 820.3 ± 77.11 mL. The data presented in this study suggest that the MDCT may be a noninvasive, rapid, and accurate investigational method for pulmonary anatomy in living lung donors.
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Affiliation(s)
- Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 501-746, Korea
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Detection of bronchial function of NHBD lung following one-h warm ischemia by organ bath model. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2009; 29:340-3. [PMID: 19513618 DOI: 10.1007/s11596-009-0315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Indexed: 10/19/2022]
Abstract
This study investigated the feasibility and effects of organ bath to be used for detection of bronchial function of non-heart-beating donor (NHBD) lung after 1-h warm ischemia. Sixteen Swedish pigs were divided into two groups randomly: heart-beating donor (HBD) group and NHBD with 1-h warm ischemia (NHBD-1 h) group. The bronchial rings whose lengths and inner diameters were both 1.5 mm were obtained from isolated left lungs of all the pigs. Acetylcholine, arachidonic acid natrium and papaverine were used to test and compare the contractile and relaxant function of bronchial smooth muscles and epithelium-dependent relaxation (EpiDR) response between HBD and NHBD-1 h groups. The results showed that there was no significant difference in the values of bronchial precontraction between HBD and NHBD-1 h groups (5.18+/-0.07 vs 5.10+/-0.11 mN, P>0.05). No significant difference in the values of EpiDR responses between HBD and NHBD-1 h groups (1.26+/-0.05 vs 1.23+/-0.07 mN, P>0.05) was observed either. During the process of EpiDR induction, the rings had no spontaneous relaxation in two groups. In addition, papaverine solution completely relaxed the bronchial smooth muscles of all bronchial rings. It was concluded that after warm ischemia for 1 h, the contractile and relaxant abilities of bronchial smooth muscles, and the epithelium-dependent adjustment both kept intact. Organ bath model could be a liable and scientific way to evaluate the bronchial function of NHBD lung.
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Oto T. Lung transplantation from donation after cardiac death (non-heart-beating) donors. Gen Thorac Cardiovasc Surg 2008; 56:533-8. [PMID: 19002751 DOI: 10.1007/s11748-008-0315-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Indexed: 12/23/2022]
Abstract
Although lung transplantation is a well-accepted treatment for advanced lung diseases, donor shortage remains a significant limiting factor resulting in an increasing number of deaths of people on waiting lists. Recently, some transplant centers have begun to use lungs retrieved from donors after circulatory arrest. This review outlines the relevant published experimental data and clinical experiences with lung transplantation from donation after cardiac-death donors (DCDs) or non-heart-beating donors (NHBDs). Techniques for lung preservation and ex vivo lung assessment of DCD (NHBD) lungs are reviewed, and aspects of primary graft dysfunction after DCD (NHBD) lung transplantation are discussed.
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Affiliation(s)
- Takahiro Oto
- Department of Cancer and Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
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Schecter MG, Elidemir O, Heinle JS, McKenzie ED, Mallory GB. Pediatric lung transplantation: a therapy in its adolescence. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2008; 11:74-79. [PMID: 18396229 DOI: 10.1053/j.pcsu.2007.12.008] [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] [Indexed: 05/26/2023]
Abstract
Pediatric lung transplant was born at the University of Toronto as an extension of the pioneering work of Cooper and Patterson in adult lung transplant in the 1980s. Through the 1990s, the field of pediatric lung transplantation grew with clinical outcomes in the largest centers being comparable to those in adult lung transplantation. For children and adults, the largest obstacle to long-term survival remains chronic allograft rejection secondary to the development of bronchiolitis obliterans, for which little advancement has been made in prevention or treatment. While transplantation has become accepted therapy for end-stage lung disease in adults, pediatric lung transplant has been less widely embraced for multiple reasons, such as adolescent non-compliance and the investment required in developing freestanding pediatric lung transplant centers. Another factor limiting pediatric lung transplant has been the paucity of suitable donor lungs. In 2002, Texas Children's Hospital and the Baylor College of Medicine successfully collaborated in developing an active and successful pediatric lung transplant program. Through our own work and an international collaborative of pediatric transplant pulmonologists and surgeons, we are hoping to move the field of pediatric lung transplant out of its "adolescence" into adulthood.
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Affiliation(s)
- Marc G Schecter
- Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
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8
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Abstract
Living donor lobar lung transplantation (LDLLT) was developed in order to mitigate the growing competition for deceased donor (DD) lungs and resultant increase in waiting list mortality. Because each of the two donor lobes serves as an entire lung for the recipient, donors who are taller than the recipient are preferred. Therefore LDLLT is particularly well suited for pediatric recipients for whom adults serve as donors. Although long-term outcomes after LDLLT reported by the Organ Procurement and Transplantation Network (OPTN) are worse compared with DD recipients, overall pediatric outcomes as well as single center reports from the most experienced programs are more promising. Particularly encouraging are the findings that bronchiolitis obliterans (OB) is less frequent or less severe in LDLLT recipients in comparison to DD recipients. Moreover, outcomes may be improved by careful selection of donors to ensure adequately sized donor lobes and minimization of infectious risks. Although no donor deaths have been reported, there is a moderate risk of significant short-term complications. Long-term follow-up has not been reported. The use of LDLLT has decreased in recent years, and the recent change by the OPTN to an urgency/benefit allocation system for DD lungs in patients 12 yr and older may further reduce the demand. Nonetheless, we anticipate that LDLLT will continue to be utilized in select circumstances, particularly in children under 12 where access to DD organs remains challenging.
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Affiliation(s)
- Stuart C Sweet
- Department of Pediatrics, Washington University in St Louis, MO, USA.
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Barr ML, Belghiti J, Villamil FG, Pomfret EA, Sutherland DS, Gruessner RW, Langnas AN, Delmonico FL. A report of the Vancouver Forum on the care of the live organ donor: lung, liver, pancreas, and intestine data and medical guidelines. Transplantation 2006; 81:1373-85. [PMID: 16732172 DOI: 10.1097/01.tp.0000216825.56841.cd] [Citation(s) in RCA: 253] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Williams GD, Ramamoorthy C. Anesthesia Considerations for Pediatric Thoracic Solid Organ Transplant. ACTA ACUST UNITED AC 2005; 23:709-31, ix. [PMID: 16310660 DOI: 10.1016/j.atc.2005.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article discusses the indications, perioperative management, postoperative complications, and patient outcome of pediatric heart transplantation and pediatric lung transplantation. Special emphasis is placed on the anesthetic considerations relevant for children who are undergoing or have received a solid thoracic organ transplant.
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Affiliation(s)
- Glyn D Williams
- Department of Anesthesia, Stanford University, CA 94305, USA.
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Duong PAT, Ferson PF, Fuhrman CR, McCurry KR, Lacomis JM. 3D-multidetector CT angiography in the evaluation of potential donors for living donor lung transplantation. J Thorac Imaging 2005; 20:17-23. [PMID: 15729118 DOI: 10.1097/01.rti.0000155040.51662.c7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In living donor lung transplant, donor lobectomies from 2 donors provide right and left lower lobes for transplantation. In the past, routine evaluation of pulmonary anatomy was not performed preoperatively. Intraoperatively, surgeons were often forced to sacrifice the lingular artery or right middle lobe segmental artery to obtain an adequate arterial cuff for safe reimplantation. This study was performed to evaluate the utility of preoperative 3D-multidetector CT angiography (3D-MDCTA) as a noninvasive method of assessing pulmonary arteries to improve donor selection and surgical planning for living lung donors. SUBJECTS AND METHODS Five potential lung donors for 2 recipients were included in the study. CT scanning with 4 channel multidetector-row CT was performed, using a modified pulmonary embolism protocol. Post-processing was performed using volume rendering techniques on a commercially available workstation. RESULTS 3D-MDCT demonstrated that there are a number of variations in pulmonary arterial anatomy and that ideal anatomy was seldom encountered. Comparison of different donors determined which lower lobes were most favorable for transplantation. Surgery confirmed the accuracy of 3D-MDCTA. There were no pulmonary arterial complications, and no vessels were sacrificed. CONCLUSION Safely explanting lower lobes from living donors for lung transplantation poses challenges not encountered in harvesting cadaveric donors or performing lobectomies for malignancy. 3D-MDCTA of pulmonary arteries can noninvasively delineate the often-complex pulmonary anatomy, which may assist in donor selection as well as reduce donor intraoperative and postoperative vascular complications.
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Affiliation(s)
- Phuong-Anh T Duong
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Barr ML, Schenkel FA, Bowdish ME, Starnes VA. Living Donor Lobar Lung Transplantation: Current Status and Future Directions. Transplant Proc 2005; 37:3983-6. [PMID: 16386604 DOI: 10.1016/j.transproceed.2005.09.112] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Living lobar lung transplantation was developed as a procedure for adult and pediatric patients considered too ill to await cadaveric transplantation. One hundred thirty-eight living lobar transplants have been performed in 133 patients at our institution between January 1993 and September 2004. Actuarial 1-, 3-, and 5-year survival are similar to ISHLT registry data. There has been no donor mortality, and morbidity has been relatively low. Long-term postoperative pulmonary function studies demonstrate the relatively smaller-sized lobes can provide similar pulmonary function and exercise capacity to bilateral cadaveric lung transplants. Living lobar lung transplantation should be considered a viable option in patients with end-stage lung disease deemed unable to await a cadaveric organ and in those patients in which further deterioration would make cadaveric transplantation inappropriate.
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Affiliation(s)
- M L Barr
- Department of Cardiothoracic Surgery, University of Southern California, Los Angeles, 90033, USA.
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Affiliation(s)
- Kalpaj Parekh
- Washington University School of Medicine, Department of Cardiothoracic Surgery, St. Louis, MO 63110, USA
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Bowdish ME, Pessotto R, Barbers RG, Schenkel FA, Starnes VA, Barr ML. Long-term Pulmonary Function After Living-donor Lobar Lung Transplantation in Adults. Ann Thorac Surg 2005; 79:418-25. [PMID: 15680807 DOI: 10.1016/j.athoracsur.2004.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Living-donor lobar lung transplantation was developed as an alternative to cadaveric transplantation. However, whether two pulmonary lobes provide comparable intermediate and long-term pulmonary function to full-sized bilateral cadaveric grafts in adults is unknown. METHODS An analysis of the pulmonary functions of 59 bilateral lobar and 43 bilateral cadaveric adult lung transplant recipients who survived more than 3 months after transplantation was performed. RESULTS Mean follow-up was 3.8 +/- 2.8 years. In lobar recipients, mean percent predicted forced vital capacity and forced expiratory volume in 1 second improved between 1 and 6 months after transplantation (42.5% +/- 13.4% and 46.9% +/- 14.0% at 1 month versus 63.6% +/- 14.1% and 64.5% +/- 13.7% at 6 months; p < 0.001 and <0.001, respectively). In cadaveric recipients, mean percent predicted forced vital capacity improved after transplantation (54.3% +/- 14.5% at 1 month versus 74.2% +/- 21.3% at 12 months; p < 0.01). As compared with the cadaveric group, mean percent predicted forced vital capacity and forced expiratory volume in 1 second were lower 1 and 3 months after transplantation in the lobar recipients (p = 0.001 at both times); however, by 6 months after transplantation, these values were comparable and remained so throughout the follow-up period. In a subset of lobar and cadaveric recipients, maximal exercise, heart rate, peak oxygen consumption, anaerobic oxygen consumption threshold, and ability to maintain oxygen saturation were also comparable. CONCLUSIONS In those adult recipients surviving more than 3 months after transplantation, lobar lung transplantation provides comparable intermediate and long-term pulmonary function and exercise capacity to bilateral cadaveric lung transplantation.
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Affiliation(s)
- Michael E Bowdish
- Department of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA
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Abstract
Organ transplantation occupies the center stage in the treatment of many forms of end-stage organ disease. When the limits of conventional medical care are exhausted, bridging therapies, cadaveric transplantation, and posttransplant medical care come to the fore. Living donor transplantation has grown out of the numerical and immunosuppression limitations of this process. Living donor transplantation medicine and surgery encompass two of the most fascinating and compelling social and ethical dilemmas of modern health care. This article provides an overview of medical and ethical concerns for those who decide to become living donors and those who care for them in the perioperative period.
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Affiliation(s)
- William T Merritt
- Department of Anesthesiology/Critical Care Medicine and Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Van Raemdonck DEM, Rega FR, Neyrinck AP, Jannis N, Verleden GM, Lerut TE. Non-heart-beating donors. Semin Thorac Cardiovasc Surg 2004; 16:309-21. [PMID: 15635535 DOI: 10.1053/j.semtcvs.2004.09.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The widespread application of lung transplantation is limited by the shortage of suitable donor organs resulting in longer waiting times for listed patients with a substantial risk of dying before transplantation. To overcome this critical organ shortage, some transplant programs have now begun to explore the use of lungs from circulation-arrested donors, so called non-heart-beating donors (NHBDs). This review outlines the different categories of NHBDs, the relevant published experimental data that support the use of lungs coming from these donors and the clinical experience worldwide so far. Techniques for NHBD lung preservation and pretransplant functional assessment are reviewed. Ethical issues involved in transplanting lungs from asystolic donors are discussed.
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Affiliation(s)
- Dirk E M Van Raemdonck
- Thoracic Surgical Research Unit, Center for Experimental Surgery and Anaesthesiology, Catholic University, Leuven, Belgium.
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Bowdish ME, Barr ML, Schenkel FA, Woo MS, Bremner RM, Horn MV, Baker CJ, Barbers RG, Wells WJ, Starnes VA. A decade of living lobar lung transplantation: perioperative complications after 253 donor lobectomies. Am J Transplant 2004; 4:1283-8. [PMID: 15268729 DOI: 10.1111/j.1600-6143.2004.00514.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Living lobar lung transplantation places two donors at risk for each recipient. We examined the perioperative outcomes associated with the 253 donor lobectomies performed at our institution during our first decade of living lobar lung transplantation. There have been no perioperative or long-term deaths. 80.2% of donors (n = 203) had no perioperative complications, while fifty (19.8%) had one or more complication. The incidence of intraoperative complications was 3.6%. Complications requiring reoperation occurred in 3.2% of donors. 15.0% of donors had other perioperative complications; the most serious were two donors who developed pulmonary artery thrombosis, while the most common was the need for an additional thoracostomy tube or a thoracostomy tube for >/=14 d for persistent air leaks and/or drainage. Right-sided donors were more likely to have a perioperative complication than left-sided donors (odd ratio 2.02, p = 0.04), probably secondary to right lower and middle lobe anatomy. This experience has shown donor lobectomy to be associated with a relatively low morbidity and no mortality, and is important if this procedure is to be considered an option at more pulmonary transplant centers, given continued organ shortages and differences in philosophical and ethical acceptance of live
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Affiliation(s)
- Michael E Bowdish
- Department of Cardiothoracic Surgery, University of Southern California Keck School of Medicine and Childrens Hospital Los Angeles, Los Angeles, CA, USA
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Warburton D, Berberich MA, Driscoll B. Stem/progenitor cells in lung morphogenesis, repair, and regeneration. Curr Top Dev Biol 2004; 64:1-16. [PMID: 15563941 DOI: 10.1016/s0070-2153(04)64001-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- David Warburton
- Developmental Biology Program, Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA
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