Experimental Study to Develop a New Procedure for Living-Donor Lobar Lung Transplantation

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Objective : Bilateral living-donor lobar lung transplantation has become an accepted alternative to cadaveric lung transplantation. Because only one lobe is implanted in each chest cavity, this procedure seems to be best suited for children and small adults. The purpose of this study was to develop a new transplant procedure which might be applied to large adult patients.Methods and Results : Unilateral double lobar lung transplantation was performed in 14 weight-matched pairs of dogs. In donor animals, the right middle, lower and cardiac lobes were separated as a right graft and the left lower lobe was separated as a left graft. In recipient animals, these two grafts were implanted in the right hemithorax after right pneumonectomy. The left graft was implanted as a right upper lobe, having been rotated 180 degrees along the vertical axis and then 180 degrees along the horizontal axis. The right graft was implanted in the natural anatomic position. Half of the recipients developed complications, such as pulmonary artery kinking and pulmonary venous thrombus, exclusively in the graft in the up-side down position. To avoid the risk of complications related to the nonanatomically positioned graft, we developed a technique of bilateral native lung-sparing lobar transplantation in which 2 grafts were implanted in the natural anatomic position. In an acute study, all six recipients showed excellent pulmonary function for 3 hours. In a chronic study, five of six (83%) recipients showed excellent pulmonary function for 3 weeks with good bronchial healing.Conclusions : Bilateral native lung-sparing lobar transplantation was technically possible and associated with satisfactory early pulmonary function with excellent bronchial healing in a canine experimental model.