J Thorac Cardiovasc Surg. 2025 Apr 19:S0022-5223(25)00274-0. doi: 10.1016/j.jtcvs.2025.03.023. Online ahead of print.
ABSTRACT
OBJECTIVE: In living-donor lobar lung transplantation (LDLLT), adult lobar graft may be small for adult recipients relative to pediatric recipients. We investigated the outcomes of adult-to-adult LDLLT relative to brain-dead donor lung transplantation (BDLT).
METHODS: Adult recipients (aged 18 years and older) who underwent LDLLT and BDLT between 2008 and 2022 were analyzed. Recipient preoperative conditions and posttransplant outcomes were compared between the 2 groups.
RESULTS: Eighty LDLLT and 177 BDLT procedures were performed. Among those, 2 LDLLT (2.5%) and 92 BDLT (52.0%) recipients underwent single-lung transplantation. LDLLT recipients showed significantly poorer preoperative conditions than BDLT recipients (P < .01), including the incidence of severe underweight (body mass index <16) (LDLLT vs BDLT: 30% vs 13.6%), frequency of hospitalization (58.8% vs 12.4%), and frequency of ventilator-dependence at transplantation (21.3% vs 7.3%). The early posttransplant outcomes of the groups were comparable, including the proportion of patients requiring extracorporeal membrane oxygenation support due to primary graft dysfunction (LDLLT vs BDLT: 8.8% vs 7.9%), 30-day mortality (1.3% vs 1.1%), and in-hospital mortality (2.5% vs 4.0%). The long-term posttransplant outcomes of the groups were comparable. The 5- and 10-year cumulative incidence of chronic lung allograft dysfunction were 29.8% and 36.1%, respectively, after LDLLT and 30.8% and 39.5% after BDLT; the 5- and 10-year survival rates were 75.3% and 59.0% after LDLLT and 75.0% and 58.2% after BDLT.
CONCLUSIONS: LDLLT can be a life-saving option for adult patients with severe preoperative conditions, showing comparable short- and long-term posttransplant outcomes to those of BDLT.
PMID:40319401 | DOI:10.1016/j.jtcvs.2025.03.023
