Artikel
Long-term outcomes of bilateral lobar lung transplantation
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Autoren
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Ilhan Inci
- Universitätsspital Zurich, Klinik für Thoraxchirurgie, Zürich
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Mace Schurmanns
- Universitätsspital Zurich, Klinik für Pneumologie, Zürich
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Peter Kestenholz
- Universitätsspital Zurich, Klinik für Thoraxchirurgie, Zürich
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Didier Schneiter
- Universitätsspital Zurich, Klinik für Thoraxchirurgie, Zürich
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Isabelle Opitz
- Universitätsspital Zurich, Klinik für Thoraxchirurgie, Zürich
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Annette Boehler
- Universitätsspital Zurich, Klinik für Pneumologie, Zürich
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Walter Weder
- Universitätsspital Zurich, Klinik für Thoraxchirurgie, Zürich
| Veröffentlicht: | 26. April 2013 |
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Gliederung
Text
Introduction: Lobar lung transplantation is an option which provides the possibility to transplant an urgent listed recipient of small size with a size mismatched donor lung. We report our short and long term results with bilateral lobar lung transplantation with long term outcomes.
Material and methods: Retrospective analyses of 75 lung transplant recipients who received down-sized lungs with special focus on 23 recipients with bilateral lobar lung transplantation (BLLT) performed since January 2000. Postoperative surgical complications, lung function tests, late complications and survival were analysed. The decision to perform lobar transplantation was considered during allocation and finally decided prior to implantation.
Results: Cystic fibrosis was the most common indication (43.5%) followed by pulmonary fibrosis (35%). Mean age at transplantation was 39 years (range, 13-66 years). Fifteen were females. Nineteen of the transplantations (83%) were done with ECMO support; 3 of them were already on ECMO prior to transplantation. There was no 30-day or in-hospital mortality. No bronchial complications occurred. The most common early complication was haematothorax (39%) which required surgical intervention. The rate of postoperative atrial arrhythmias was 30%.
Forced expiratory volume in 1 second (% predicted) at 1 and 2 years was 82 ± 23 and 79 ± 22, respectively (median ± standard deviation). By 2-years follow-up bronchiolitis obliterans syndrome (BOS) was documented in 3 patients with a median follow-up of 1457 days.
Overall survival at 1 and 5 years was 82% and 64% respectively and comparable to 219 other recipients who received bilateral lung transplantation during the same period (Log Rank test, p=0.56).
Conclusion: This study demonstrates that BLLT has a comparable short and long term outcome as standard bilateral lung transplantation. Limitation of lung transplantation due to size-mismatch, especially in smaller recipients could be overcome by utilizing lobar lung transplantation.
