Size-reduced lung transplantation: An advanced operative strategy to alleviate donor organ shortage

Aigner, Clemens; Winkler, G.; Jaksch, Péter; Ankersmit, Hendrik Jan; Marta, Gabriel; Taghavi, S.; Wisser, Wilfried; Klepetko, Walter

doi:10.1016/j.transproceed.2004.09.066

Cited by 61 publications

(50 citation statements)

References 6 publications

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“…This practice is also associated with a reduced risk of primary graft dysfunction after lung transplantation (18). It is common for transplant surgeons to reduce the volume of the allograft during transplant surgery, and lobar transplantation is an accepted transplant procedure (19)(20)(21)(22). Together these data suggest that it may be reasonable to perform lobar transplantation or surgically downsize substantially oversized allografts for shorter transplant candidates and expect that outcomes would be no worse, and perhaps better, than a strategy that includes an extended waiting period until a small allograft is available.…”

Section: Discussionmentioning

confidence: 99%

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Sell¹,

Bacchetta²,

Goldfarb

et al. 2016

Am J Respir Crit Care Med

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Rationale: Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates.Objectives: To examine the relationship between lung transplant candidate height and waiting list outcomes.Methods: We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year. Measurements and Main Results:The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (,162 cm) and 202.0 per 100 person-years among candidates of average stature (170-176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29-39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24-96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10-85%) higher rate of respiratory failure while awaiting lung transplantation.Conclusions: Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height.

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Section: Discussionmentioning

confidence: 99%

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Sell¹,

Bacchetta²,

Goldfarb

et al. 2016

Am J Respir Crit Care Med

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“…To prevent overloading the pulmonary vascular bed, cardiopulmonary bypass or ECMO support is recommended during the operation. 1,6,11 We started ECMO support before first lobe had been reperfused, but after bilateral lung release, hila dissection, and bleeding control had been done, excessive bleeding due to systemic heparinization was prevented.…”

Section: Discussionmentioning

confidence: 99%

“…4 Since that date, many cases have been done by different centers. 5,6 We present the first case of a successful brain dead donor bilateral lobar LTx done in Turkey in 2013 in our clinic.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Yeginsu

Kutlu²,

Kalamanoğlu³

et al. 2014

Exp Clin Transplant

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A 57-year-old woman with severe bilateral bronchiectasis was evaluated for lung transplant. She was 148 cm tall and weighed 46 kg. Her FEV 1 was 0.63 liters (32% of predicted). Her PAO 2 was 64.6 mm Hg, and her Pa CO2 was 44 mm Hg. All of her cardiac functions were within normal ranges. Her mean pulmonary arterial pressure was 32 mm Hg. She had no infections and no other systemic diseases. She was psychologically well and eager to undergo the lung transplant.She underwent a bilateral brain dead donor lobar lung transplant. After the recipient pneumonectomies had been performed, bilateral lower lobes were implanted sequentially. She was given extracorporeal membrane support during the operation. Her postoperative course was uneventful. Chest drains were removed after 8 days. She went to the general ward on the fifth postoperative day, and was discharged on the 15 th day. As of this writing, she has had no problems through the ninth month follow-up. To the best of our knowledge, she is the first case of successful bilateral brain dead donor lung transplant in our country.

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“…From that time the number of SLT procedures grew until 2000, and from then onwards, BLTx became and remains the dominant procedure in lung replacement. Other innovations over the years include cut down lung transplant procedures (to overcome donor and recipient size discrepancies) where the lung volume is reduced (usually by lobectomy) in situ or on the back table [7,8], and lobar transplant techniques that have been developed to allow either transplantation from live donors [9,10] or splitting of a single large lung allowing bilateral replacement in a smaller recipient [11].…”

Section: Bltx Versus Slt Versus Hltxmentioning

confidence: 99%