What is living donor lung transplantation?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

Transplantation of lobes from living donors involves bilateral implantation of the lower lobes from two blood group–compatible living donors. Donation of a lobe decreases the donor's lung volume by an average of approximately 15% and, consequently, is not associated with long-term functional limitation.

Living-donor lobar lung transplantation (LDLLT) has been used as an option for patients who are considered too ill to await cadaveric transplantation. [6] The procedure was initially performed in patients with cystic fibrosis, although the indications were subsequently broadened. The functional and survival outcomes with LDLLT are similar to those achieved with conventional transplantation of cadaveric lungs. 

There have been a total of 253 LDLLT in the United States since 1990; however, no LDLLT has been performed in the US since 2013. [1]  

Despite fairly extensive experience, no donor mortality has been reported. In a study of 369 live lung donors serious complications occurred in 18% of donors; 2.2% underwent reoperation and 6.5% had an early rehospitalization. No deaths occurred and no donors underwent lung transplantation during 4000+ person-years of follow-up (death: minimum 4, maximum 17 years; transplant: minimum 5, maximum 19). Live lung donation remains a potential option for recipients when using deceased donor lungs lacks feasibility. However, in the United States the use of two live donors for each recipient and the risk of morbidity associated with live lung donation do not justify this approach when deceased lung donors remain available. [7]

In recent years, most of the reports on LDLLT have been from Japan, where the average waiting time for a cadaveric lung is exceeding 800 days. LDLLT has been performed both for adult and pediatric patients suffering from various end-stage lung diseases including restrictive, obstructive, vascular, and infectious conditions. [8]

Compared with bilateral cadaveric lung transplants, long-term studies have shown that the relatively smaller-sized lobes can provide similar pulmonary function and exercise capacity. Living lobar lung transplantation should be considered in a patient with a clinically deteriorating condition. Although no deaths have been reported in the donor cohort, a risk of death between 0.5% and 1% should be quoted, pending further data. A case series of 128 living lobar lung transplantations performed in 123 patients between 1993 and 2003 was published. [9]  The actuarial survival among the living lobar recipients was 70%, 54%, and 45%, at 1, 3, and 5 years, respectively. [9]


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