Clinical analysis of bilateral lobar lung transplantation on end-stage lung disease in patients with size mismatching thoracic cavity / 中华器官移植杂志

ABSTRACT

Objective To investigate the effectiveness and safety of bilateral lobar lung transplantations (LLTx) in thoracic cavity size mismatching patients with end-stage lung diseases and analyze its prognosis.Method Clinical data of 34 patients receiving LLTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2012.LLTx were performed on 14 male and 20 female patients,with a mean age of 37.0 ± 6.3 years (ranging from 15 to 56 years).Indications for LLTx were idiopathic pulmonary fibrosis (n =24),idiopathic pulmonary hypertension (n =2),Eisenmenger syndrome (n =3),bronchiectasis (n =2) and lymphangiomyomatosis (n =3).Amongst them 26 patients received LLTx under extracorporeal membrane oxygenation (ECMO) support and 3 on ECMO as a bridge to transplantation.Twenty-four middle/lower right lobes with left lower LLT,4 bilateral lower LLT,2 bilateral superior LLT and 4 split left lung LLT were performed.Ischemic time was 4.4± 1.2 h for the first lobe and 6.3 ± 1.4 h for the second.Result The mortality in postoperative prophase (30 days) was 23.5％.The 1-,2-,3-and 5-year survival rate after LLTx was 70.9％,60.8％,50.6％ and 36.2％ respectively.The main causes of mortality included primary graft dysfunction,acute rejection,multiple organ failure,bronchiolitis obliterans and sepsis.Lung function test was performed on 23 cases after transplantation and forced expiratory volume in first second,maximal voluntary ventilation accounting for the predicted value was (74.23 ± 4.86)％ and (72.0 ± 3.64)％,respectively.Conclusion This study demonstrates that for thoracic cavity size mismatching patients,LLTx are safe and effective in the treatment of end-stage lung diseases,which can ameliorate the lung function and prognosis.