Outcomes of adult-to-adult living-donor lobar lung transplantation: A single institution experience.

Abstract

In living-donor lobar lung transplantation (LDLLT), adult lobar graft may be small for adult recipients relative to pediatric recipients. We investigated the outcomes of adult-to-adult LDLLT relative to brain-dead donor lung transplantation (BDLT). Adult recipients (aged 18 years and older) who underwent LDLLT and BDLT between 2008 and 2022 were analyzed. Recipient preoperative conditions and posttransplant outcomes were compared between the 2 groups. Eighty LDLLT and 177 BDLT procedures were performed. Among those, 2 LDLLT (2.5%) and 92 BDLT (52.0%) recipients underwent single-lung transplantation. LDLLT recipients showed significantly poorer preoperative conditions than BDLT recipients (P < .01), including the incidence of severe underweight (body mass index <16) (LDLLT vs BDLT: 30% vs 13.6%), frequency of hospitalization (58.8% vs 12.4%), and frequency of ventilator-dependence at transplantation (21.3% vs 7.3%). The early posttransplant outcomes of the groups were comparable, including the proportion of patients requiring extracorporeal membrane oxygenation support due to primary graft dysfunction (LDLLT vs BDLT: 8.8% vs 7.9%), 30-day mortality (1.3% vs 1.1%), and in-hospital mortality (2.5% vs 4.0%). The long-term posttransplant outcomes of the groups were comparable. The 5- and 10-year cumulative incidence of chronic lung allograft dysfunction were 29.8% and 36.1%, respectively, after LDLLT and 30.8% and 39.5% after BDLT; the 5- and 10-year survival rates were 75.3% and 59.0% after LDLLT and 75.0% and 58.2% after BDLT. LDLLT can be a life-saving option for adult patients with severe preoperative conditions, showing comparable short- and long-term posttransplant outcomes to those of BDLT.