Pulmonary bipartitioning and lobar transplantation: A new approach to donor organ shortage

摘要: Abstract The scarcity of small donors has significantly limited lung transplantation for pediatric and adult patients. Use single lobes procured from size-unmatched overcome this difficulty, but only in a few selected cases and, addition, it represents waste tissue. In an animal model we have shown that is possible to divide one with careful partitioning the vascular bronchial structures thus obtain two viable lobar grafts suitable bilateral implantation smaller animal. We now applied procedure clinically seven patients operated on between May 1993 November 1994. indications were cystic fibrosis three children, primary pulmonary hypertension adults, bronchiectasis one, idiopathic one. There children aged 13 17 years (median 14) four adults 40 53 45). was 46% 50% discrepancy weight recipient donor 12% 17% height. surgical technique consisted left lung, anterior thoracotomy recipient, use cardiopulmonary bypass, lower lobe hemithorax upper right hemithorax. Vascular connections facilitated by leaving long pedicle side. artery anastomosis done "fissure" side ensure without tension. An end-to-end overcame problem size discrepancy. Six are alive well 10 27 months 19) after operation. One patient died systemic aspergillosis infection. All discharged hospital within first or second postoperative month. No technical problems identified: repeated bronchoscopy demonstrated satisfactory healing early stricture formation. remain subjectively good exercise tolerance all achieve greater than 70% predicted values forced expiratory volume 1 second. Perfect adaptation transplanted pleural space been computed tomographic scan. conclusion, when there large donor. This may help resolve availability population. (J Thorac Cardiovac Surg 1997;113:529-37)