Living Lobar Lung Transplant:
Diagrammatical Explanation of Procedure
Lobar pulmonary transplantation at our institution has expanded from implantation of a unilateral lobe in neonatal/pediatric patient to bilateral living related lobar transplantation in selected patients with cystic fibrosis. Donor lobectomies for living-related lobar transplantation require a thorough evaluation of potential donors, as well as modification of standard lobectomy and pulmonary preservation techniques.
Criteria for donor acceptance are as follows:
- Age less than or equal to 55 years
- No significant past medical history
- No recent viral infections
- Normal echocardiogram
- Normal chest roentgenogram
- Oxygen tension > 85% on room air
- Forced expired volume in 1 second and forced vital capacity >85% predicted
- No significant pulmonary pathology on computed tomography
- No previous thoracic operation on donor side
After appropriate donors are identified, one is selected for right lower lobectomy and the other for left lower lobectomy. The transplantation procedure is as follows:
Diagrammatical Explanation of Procedure
Figure 1.
Dissection and division of the pulmonary artery
for donor right lower lobectomy. Next Figure
Figure 2.
Dissection of the right inferior pulmonary vein
so that a vascular clamp can be placed on the
intrapericardial left atrium. Next Figure
Figure 3.
Dissection and division of the bronchus
to the right lower lobe. Next Figure
Figure 4.
Dissection and division of the pulmonary artery
for donor left lower lobectomy. Next Figure
Figure 5.
Dissection and division of the bronchus
to the left lower lobe.
As recipient lists for patients in need of lung transplantation continue to grow, donor availability remains constant. Therefore, many patients with end-stage pulmonary disease will die while waiting for donor lungs. We believe that donor left and right lower lobectomies for living-related bilateral transplantation provide a source of donor lungs for selected patients in need of bilateral lung transplantation.
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