Right single lung transplantation using an inverted left donor lung: interposition of pericardial conduit for pulmonary venous anastomosis - a case report

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.

Technical Aspects of Lung Transplantation: Adverse Events and Circumstances

“…In left-inverted to right lung transplantation, anastomosis does not present difficulties because the donor pulmonary artery is in the anterior superior part of the bronchus and runs downwards, as does the recipient’s pulmonary artery. As the likelihood of kinking is high, shortening the donor pulmonary artery as much as possible is recommended, as is leaving the recipient pulmonary artery as long as possible [ 11 ].…”

“…As the likelihood of kinking is high, shortening the donor pulmonary artery as much as possible is recommended, as is leaving the recipient pulmonary artery as long as possible [11].…”

Lung transplantation for Kartagener syndrome: technical aspects and morphological adaptation of the transplanted lungs

“…Lung transplantation (LT) has been demonstrated as a feasible therapeutic option for patients with KS who present with progressive bronchiectasis and chronic respiratory failure, with similar reported long-term outcomes to those of LT for other diseases [1][2][3][4][5][6]. In LT for KS, an elaborate surgical technique is required to adjust for the orientation mismatch of the hilar structures between the recipient and the donor, especially for pulmonary arterial anastomosis, as applied in inverted LT [1][2][3][4][5][6][7]. Moreover, the normal anatomical lungs from the donor is morphologically necessitated to fit into the recipient's chest cavity in the presence of situs inversus with dextrocardia.…”