A decade of living lobar lung transplantation: recipient outcomes

J Thorac Cardiovasc Surg. 2004 Jan;127(1):114-22. doi: 10.1016/j.jtcvs.2003.07.042.


Objective: Living lobar lung transplantation was developed as a procedure for patients considered too ill to await cadaveric transplantation.

Methods: One hundred twenty-eight living lobar lung transplantations were performed in 123 patients between 1993 and 2003. Eighty-four patients were adults (age, 27 +/- 7.7 years), and 39 were pediatric patients (age, 13.9 +/- 2.9 years).

Results: The primary indication for transplantation was cystic fibrosis (84%). At the time of transplantation, 67.5% of patients were hospitalized, and 17.9% were intubated. One-, 3-, and 5-year actuarial survival among living lobar recipients was 70%, 54%, and 45%, respectively. There was no difference in actuarial survival between adult and pediatric living lobar recipients (P =.65). There were 63 deaths among living lobar recipients, with infection being the predominant cause (53.4%), followed by obliterative bronchiolitis (12.7%) and primary graft dysfunction (7.9%). The overall incidence of acute rejection was 0.8 episodes per patient. Seventy-eight percent of rejection episodes were unilateral. Age, sex, indication, donor relationship, preoperative hospitalization status, use of preoperative steroids, and HLA-A, HLA-B, and HLA-DR typing did not influence survival. However, patients on ventilators preoperatively had significantly worse outcomes (odds ratio, 3.06, P =.03; Kaplan-Meier P =.002), and those undergoing retransplantation had an increased risk of death (odds ratio, 2.50).

Conclusion: These results support the continued use of living lobar lung transplantation in patients deemed unable to await a cadaveric transplantation. We consider patients undergoing retransplantations and intubated patients to be at significantly high risk because of the poor outcomes in these populations.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • California
  • Cause of Death*
  • Child
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Graft Rejection
  • Graft Survival
  • Humans
  • Lung Transplantation / methods
  • Lung Transplantation / mortality*
  • Lung Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Probability
  • Quality of Life*
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Sickness Impact Profile
  • Survival Rate
  • Time Factors