Watanabe Yui, Watanabe Tatsuaki, Hirama Takashi, Murai Sho, Ueda Kazunori, Oishi Hisashi, Akiba Miki, Watanabe Toshikazu, Suzuki Takaya, Notsuda Hirotsugu, Onodera Ken, Togo Takeo, Niikawa Hiromichi, Noda Masafumi, Okada Yoshinori
Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan.
Organ Transplant Center, Tohoku University Hospital, Sendai, Japan.
Surg Case Rep. 2024 Oct 23;10(1):238. doi: 10.1186/s40792-024-02046-x.
Lung transplantation is a vital option for patients with end-stage lung disease. However, it faces a significant challenge due to the shortage of compatible donors, which particularly affects individuals with small chest cavities and pediatric patients. The novel approach of cadaveric lobar lung transplantation is a promising solution to alleviate the donor shortage crisis. Both the mid-term and long-term outcomes of lobar lung transplantation are comparable to those of standard lung transplantation. However, patients undergoing lobar lung transplantation reported a significantly higher rate of primary graft dysfunction compared to patients undergoing standard lung transplantation. Therefore, careful donor selection is critical to improve outcomes after lobar transplantation. However, no established method exists to evaluate each lung lobar graft of deceased donors. This case report describes a case of cadaveric lobar lung transplantation to overcome size mismatch and donor shortage, with particular emphasis on lobar graft evaluation.
A 39-year-old woman with scleroderma-related respiratory failure was listed for deceased donor lung transplantation due to a rapidly progressing disease. Faced with a long waiting list and impending mortality, she underwent bilateral living-donor lobar lung transplantation donated by her relatives. Post-transplant complications included progressive pulmonary vein obstruction and pleural effusion, which ultimately required retransplantation. An oversized donor with pneumonia in the bilateral lower lobes was allocated. Lung ultrasound was used to evaluate each lung lobar graft during procurement. The right upper and middle lobes and left upper lobe were confirmed to be transplantable, and lobar lung redo transplantation was performed. The patient's post-transplant course was uneventful, and she was discharged home and returned to her daily activities.
This case highlights the clinical impact of cadaveric lobar lung transplantation as a feasible and effective strategy to overcome the shortage of donor lungs, especially in patients with small thoracic cavities. By establishing donor lung evaluation techniques and overcoming anatomical and logistical challenges, cadaveric lobar lung transplantation can significantly expand the donor pool and offer hope to those previously considered ineligible for transplantation.
肺移植是终末期肺病患者的重要治疗选择。然而，由于合适供体短缺，肺移植面临重大挑战，这尤其影响胸腔较小的个体和儿科患者。尸体肺叶移植的新方法是缓解供体短缺危机的一个有前景的解决方案。肺叶移植的中期和长期结果与标准肺移植相当。然而，与接受标准肺移植的患者相比，接受肺叶移植的患者原发性移植功能障碍发生率显著更高。因此，仔细选择供体对于改善肺叶移植后的结果至关重要。然而，目前尚无既定方法来评估已故供体的每个肺叶移植物。本病例报告描述了一例尸体肺叶移植病例，以克服大小不匹配和供体短缺问题，特别强调肺叶移植物评估。
一名39岁患有硬皮病相关呼吸衰竭的女性，因病情迅速进展被列入已故供体肺移植名单。面对漫长的等待名单和迫在眉睫的死亡风险，她接受了亲属捐赠的双侧活体供体肺叶移植。移植后并发症包括进行性肺静脉阻塞和胸腔积液，最终需要再次移植。分配了一名患有双侧下叶肺炎的超大供体。在获取过程中使用肺部超声评估每个肺叶移植物。确认右上叶、中叶和左上叶可用于移植，并进行了肺叶再次移植。患者移植后的病程顺利，出院回家并恢复了日常活动。
本病例突出了尸体肺叶移植作为一种可行且有效的策略来克服供肺短缺的临床影响，特别是在胸腔较小的患者中。通过建立供肺评估技术并克服解剖和后勤方面的挑战，尸体肺叶移植可以显著扩大供体库，并为那些以前被认为不符合移植条件的患者带来希望。
