Possibility of sequential transplantation of brain-dead donor single lung and contralateral living-donor lobe

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Brain-dead donor lung scarcity is a problem worldwide. Although in Japan bilateral living donor lobar lung transplantation is more popular than brain-dead donor lung transplantation, it is often impossible to ensure two living donors. To investigate the possibility of sequential transplantation of brain-dead donor single lung and contralateral living-donor lobe, instead of brain-dead bilateral single lung transplantation or bilateral living-donor lobar transplantation, canine model was designed. Left single lung graft was harvested from a donor beagle dog and preserved under cold saline immersion (4C) for 6 hours. Right upper and middle lobe block was also harvested from another beagle and preserved in the same manner for 1 hour. In a recipient beagle, left single lung implantation was made first. Without reventilation and reperfusion of the first lung under topical cooling, right upper and middle lobe block was implanted, under a cardio-pulmonary support machine, with bronchus to recipient right main bronchus, pulmonary artery to lower trunk in end to side fashion, and pulmonary vein to superior pulmonary vein. After the anastomoses were completed, recipient native right lower and mediastinal lobes were resected and then ventilation and reperfusion were started in both lungs with gradual tapering of the cardio-pulmonary support. Approximately ischemic time is 8 hours in the left graft and 2 hours in the right. Respiratoty and circulatory change were monitored up to 6hours and the most effective management was studied.