ISRAEL SOCIETY OF PULMONARY MEDICINE ANNUAL ... - e-Med

Living Donor Lobar Lung Transplantation
MR Kramer, MD
Rabin Medical Center
Although cadaveric lung transplantation (CLT) offers acceptable prospects for 5-year
survival, donor shortage remain to be a major problem. In an effort to address the
donor shortage issue, living-donor lobar lung transplantations (LDLLT) have been
performed in some institutions.
As of 2007, LDLLT has been performed in approximately 350 patients worldwide.
The survival appears to be similar to or even better than International Society for
Heart and Lung Transplantation registry data on CLT.
The operation requires parallel 3 operative teams but technically is only slightly
more complicated then a standard cadaveric transplant. This type of procedure has
been performed recently in a case of pulmonary fibrosis post bone marrow
transplantation in Israel however despite the technical success the patient died of
multi-organ failure.
Although the possible risk for the donor with standard lobectomy is small it is not
negligible and therefore LDLLT should be reserved only for very sick patients by a
well-prepared program. This type of procedure should be applied mostly to young
patients with cystic fibrosis but can be offered to restrictive, obstructive, infectious,
and hypertensive lung diseases for both pediatric and adult patients who would die
soon otherwise. A strong motivated and supportive family is needed to facilitate
such a procedure.
39