Update on living-donor lobar lung transplantation

Abstract

Living-donor lobar lung transplantation (LDLLT) has been performed as a life-saving procedure for critically ill patients who are unlikely to survive the long wait for cadaveric lungs. This article will review the current status of LDLLT. As of 2011, LDLLT has been performed in approximately 400 patients worldwide. The use of LDLLT has decreased in the USA because of the recent change by the Organ Procurement and Transplantation Network to an urgency/benefit allocation system for cadaveric donor lungs. During the past several years, reports on LDLLT have been most exclusively from Japan where the average waiting time for a cadaveric lung is more than 2 years. LDLLT has been performed various lung diseases including bronchiolitis obliterans following hematopoietic stem cell transplantation. Successful LDLLTs have been reported for patients receiving oversized as well as undersized grafts. The 5-year survival after LDLLT was 74.6% in the 2008 official report of the Japanese Society of Lung and Heart-Lung Transplantation, and it was 88.8% in the author's personal experience. LDLLT can be performed for various lung diseases and appears to provide similar or better survival than cadaveric lung transplantation. Size mismatching can be overcome to a certain extent using various surgical techniques.