Short-term outcome in living donors for lung transplantation: the role of preoperative computer tomographic evaluations of fissures and vascular anatomy

Abstract

Summary Successful living‐donor lobar lung transplantation (LDLLT) largely depends on donor outcome. We reviewed our experiences with LDLLT and focused on preoperative computed tomographic evaluations of donors. Twenty‐five LDLLTs were performed in Kyoto University. As a routine preoperative assessment, high‐resolution chest computed tomography (CT), and three‐dimensional (3D)‐CT angiography were performed. Preoperative evaluations, surgical procedures, and early postoperative outcomes were reviewed in 43 consecutive LDLLT donors. All donors were discharged home after the donor lobectomies. Severely incomplete fissures were intraoperatively identified in two donors, whose interlobar fissures were mostly not identified by high resolution CT preoperatively. Preoperative 3D‐CT angiography was effective for the identification of the branches of the pulmonary artery and vein. Pulmonary arterioplasties were performed with auto pericardial patches in three left donors. The bilateral donors had to be exchanged because of an anomaly of the pulmonary veins in one donor. Small pulmonary arterial branches to the remaining lobes were to be sacrificed in 23 donors (53%). Early postoperative complications were ascertained in seven donors, and five of them presented air leak‐related complications. Living donor lobectomies were safely performed with low morbidities in our institution. Preoperative computer tomographic evaluations might be useful in donor lobectomies.

Outcomes of various transplant procedures (single, sparing, inverted) in living-donor lobar lung transplantation

“…It is indicated when total graft FVC Abbreviations and Acronyms CLT ¼ cadaveric lung transplantation ECMO ¼ extracorporeal membrane oxygenation FVC ¼ forced vital capacity LDLLT ¼ living-donor lobar lung transplantation 3D-CT ¼ 3-dimensional computed tomography was less than 60% of the recipient's predicted FVC or when donor's left lower lobectomy would be technically difficult as the result of interlobar pulmonary artery anatomy. 19 The technical details have been described previously. 15 At the time of left pneumonectomy in the recipient, upper and lower bronchi are stapled separately.…”

Postoperative pulmonary function and complications in living-donor lobectomy

“…One reasons for the low rate of intraoperative complications in our series was that we performed pre-operative anatomic evaluation with 3D CT angiography in all donors. 10 In lobectomies that are performed for the use of the lobe in transplantation, the proximal dissection of the structures may often be the cause of prolonged air leakage. 4,7 No donors in our study developed prolonged air leak for Z 2 weeks, and only 5 donors (6%) required chest drainage for 4 1 week because of air leak after surgery.…”

“…9,10 Surgeons involved in the donor and recipient surgeries met to analyze the CT findings in every LDLLT case. The analysis focused on identifying incomplete fissures and evaluating the state of the vessel branches and the bronchial branches.…”

Impact of donor chest radiography on clinical outcome after lung transplantation

“…Thus, improved imaging might be beneficial and chest CT, although not mandatory, is nowadays increasingly used in the pre-transplant setting. More advanced imaging such as chest CT contributes supplementary information that could potentially have an impact on the outcome, such as highlighting technical challenges in patients with previous lung or heart surgery (38) and help with identification of anatomical structures and their measurements in living lung donors (39,40). Several studies have evaluated lung volume assessed by CT on non-transplant patients, and successfully compared the results with lung capacity results from lung function tests, indicating that CT volume measurements are better than those based on demographic data or radiography (41)(42)(43).…”