Bronchial healing after living-donor lobar lung transplantation

Toyooka, Shinichi; Yamane, Masaomi; Oto, Takahiro; Sano, Yoshifumi; Okazaki, Masaharu; Date, Hiroshi

doi:10.1007/s00595-008-4049-3

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…We have accepted highdose systemic corticosteroid therapy in LDLLT. Excellent bronchial healing was observed in spite of high-dose steroid use (25). Various factors, such as short donor bronchial length, high blood flow in the small grafts implanted, well preserved lung parenchyma with short ischemic time, may contribute to better oxygen supply to the donor bronchus resulting in excellent bronchial healing in LDLLT.…”

Section: Strategies For Organ Shortagementioning

confidence: 98%

Current status and problems of lung transplantation in Japan

Date

2016

J. Thorac. Dis.

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Lung transplantation has been performed worldwide and recognized as an effective treatment for patients with various end-stage lung diseases. Shortage of lung donors is one of the main obstacles in most of the countries, especially in Japan. Every effort has been made to promote organ donation during the past 20 years. In 2010, Japanese transplant low was revised so that the family of the brain dead donors can make a decision for organ donation. Since then, the number of cadaveric lung donor has increased by 5-fold. However, the average waiting time is still more than 800 days resulting in considerable number of deaths on the waiting list. Lung transplantation in the use of donation after cardiac death (DCD) has now been increasingly performed in Europe, Australia and North America with promising results. However, controlled death is not permitted in Japan making it difficult to accept this strategy. Use of marginal donors is one of the strategies for organ shortage. In Japan, the rate of lung usage is now well over 60% because of careful donor management by medical consultants and aggressive use of marginal donors. Living-donor lobar lung transplantation (LDLLT) has been developed to offset the mismatch between supply and demand for those patients awaiting cadaveric lung transplantation (CLT) and it is often the most realistic option for very ill patients. Between 1998 and 2015, lung transplantation has been performed in 464 patients (55 children, 419 adults) at 9 lung transplant centers in Japan. CLT was performed in 283 patients (61%) and LDLLT was performed in 181 patients (39%). The 5-year survival was 72.3% and 71.6%, respectively. Of note, only seven children received CLT. In conclusion, lung transplantation in Japan has grown significantly with excellent results but the shortage of cadaveric lung donor remains to be an important unsolved problem. LDLLT is often the only realistic option for very ill patients especially for children.

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Section: Strategies For Organ Shortagementioning

confidence: 98%

Current status and problems of lung transplantation in Japan

Date

2016

J. Thorac. Dis.

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“…14 Many other reports of pathological mechanisms have been submitted -mechanisms such as the macrophage migration inhibitory factor expressed in lung cancer tissue 15 and bronchial healing after lobar lung transplantation. 16 In a case-control study that assessed the usefulness of adjuvant therapy with a bacillus Calmette-Guérin cell wall skeleton, following surgery for non-small cell lung cancer, the survival rate was higher in patients with adjuvant therapy than in those without it, but the difference was not signifi cant. 17 A report on sentinel lymph node biopsy after preoperative chemotherapy for breast cancer is also noteworthy.…”

Section: Respiratory Mammary Gland and Endocrinementioning

confidence: 99%

Current status of and prospects for the English medical journal Surgery Today

Maehara

Kakeji

2010

Surg Today

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“…Although we have accepted patients with high-dose systemic corticosteroid therapy in LDLLT, excellent bronchial healing was obtained in most of the recipients. Various factors including short donor bronchus, relatively high blood flow into the small grafts, normal lung parenchyma with short ischemic time, are contributors of better oxygen supply to the donor bronchus and excellent bronchial healing in LDLLT (35).…”

Section: Comparison With Cltmentioning

confidence: 99%

Living-related lung transplantation

Date

2017

J. Thorac. Dis.

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Living-donor lobar lung transplantation (LDLLT) was developed to deal with the severe shortage of brain dead door for patients who would not survive the long waiting period. In standard LDLLT, right and left lower lobes removed from two healthy donors are implanted into a recipient after right and left pneumonectomies using cardiopulmonary bypass (CPB). The number of LDLLT has decreased in the USA due to the recent change in allocation system for cadaveric donor lungs. For the past several years, most of the reports on LDLLT have been from Japan, where the average waiting time for a cadaveric lung is exceeding 800 days. LDLLT has been performed both for adult and pediatric patients suffering from various end-stage lung diseases including restrictive, obstructive, vascular and infectious lung diseases. Since only two lobes are implanted, size matching is a very important issue. Functional size matching by measuring donor pulmonary function and anatomical size matching by three-dimensional computed tomography (3D-CT) volumetry are very useful. For oversize graft, we have employed several techniques, including single lobe transplantation, delayed chest closure, downsizing the graft, and middle lobe transplantation. In cases of undersize mismatch, native upper lobe sparing transplant or right-left inverted transplant was performed.The 5-, 10-and 15-year survivals were 80.8%, 72.6% and 61.7%, respectively. There was no difference in survival between standard LDLLT and non-standard LDLLT such as single, sparing and inverted transplant.All donors have been discharged without any restrictions. LDLLT is a viable option for very ill patients who would not survive a long waiting time for cadaveric lungs. We have successfully developed various surgical techniques to overcome size mismatching with favorable outcome.

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Bronchial healing after living-donor lobar lung transplantation

Abstract: Our study suggests that bronchial healing after LDLLT is acceptable.

Cited by 7 publications

References 23 publications

Current status and problems of lung transplantation in Japan

Current status and problems of lung transplantation in Japan

Current status of and prospects for the English medical journal Surgery Today

Living-related lung transplantation

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