gms | German Medical Science

Objective: Lobar lung transplantation (LLuTX) is a therapeutic option mainly for urgent small recipients. Only series with limited numbers have been reported. This approach is technically more demanding than standard LuTX or simple downsizing by wedge resections. In our center this approach was liberally applied and we report the largest series of lobar LuTX so far.

Methods: We performed an analysis of our prospective lung transplant database from 1/2001 to 12/2012 and compared the clinical outcome of lobar LuTX recipients to those receiving standard donor organs or downsizing by simple peripheral wedge resection.

Results: 778 LuTX (group 1) were performed either in standard technique (n=539) or with downsizing by wedge resections (n=239). 138 LuTX were performed in lobar technique (group 2). In group 1 there were significantly less females (45.2% vs. 58.0 %; p=0.006). Patients in group 1 were significantly older (median 51.6 (0.6–71.4) vs. 36.4 (7.3–72.2) years; p<0.001), had a different spectrum of diagnoses (CF: 18.4 % vs. 34.8%; Fibrosis: 19.4% vs. 33.3%; PAH: 6.0% vs. 5.8%; COPD: 40.4% vs. 11.6%; p<0.001) were less frequently ventilated prior to LuTX (5.7% vs. 19.7%; p<0.001) and required less often extracorporeal support as bridging (2.5% vs. 13.1%; p<0.001). Intubation time was shorter in group 1 (median 1.0 (0–134) vs. 6.0 (1–61) days; p<0.001) as well as ICU stay (median: 6.0 vs. 17.0 days; p<0.001) and hospital stay (median: 22.0 vs. 33.5 days; p<0.001). BOS rate was significantly lower in group 2 (24.8% vs. 12.8%; p=0.006). In hospital mortality was higher in group 2 (7.6% vs. 20.3%; p<0.005). 1 year survival was 65,1% vs.84,8%; 3 years survival 63,1% vs.77,1% and 5 years survival 54,9% vs.69,9% (p<0,001). Regarding only the patients who were successfully dismissed from hospital, survival was comparable between the groups (p=0.168).

Conclusion: Patients receiving lobar transplantation represent a different patient group than those receiving standard LuTX. The observed early postoperative outcome is in contrast to previous publications inferior to standard LuTX recipients, which is explained by the different indication spectrum and a higher rate of patients invasively bridged to transplantation. However, long term outcome of hospital survivors is comparable to standard LuTX and LLuTX remains an important option in the management of urgent small recipients.