Heterotopic lung transplant: a feasible approach to compensate for organ shortages

Abstract

Lung transplantation is still limited by the shortage of suitable donor lungs, especially during the COVID-19 pandemic. Heterotopic lung transplantation (HLTx), as a flexible surgical procedure, can maximize the potential of donor lungs in an emergency, but its wide spread is hindered by difficulties in anastomosis and paucity of outcome data. Retrospective review of four patients receiving HLTx over 1 year, including 1 left-to-right single HLTx, 2 right-to-left single HLTxs, and 1 lobar HLTx (right upper lobe-to-left). Median recipient age was 58.5 years (46–68), and 3 patients were male. Post-operative hospital stay was 33 days (30–42). One recipient lived for 10 years and died of bronchiolitis obliterans syndrome, others were alive with no major morbidity at 12 to 31 months after operation with a 1-year survival of 100%. The follow-up chest imaging showed transplanted lungs could be inflated well and adapt morphologically to fill the thoracic cavity in short and long term. This study demonstrates that HLTx, as a feasible alternative to conventional lung transplantation in emergency cases, could be considered in selected patients at advanced medical centers.