• Akihiro Takahagi, Toyofumi F Chen-Yoshikawa, Masao Saito, Ryo Okabe, Fumiaki Gochi, Hiroya Yamagishi, Masatsugu Hamaji, Hideki Motoyama, Daisuke Nakajima, Akihiro Ohsumi, Akihiro Aoyama, Makoto Sonobe, and Hiroshi Date.
• Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
• J. Heart Lung Transplant. 2019 Jan 1; 38 (1): 66-72.

BackgroundWe have developed a novel method for native upper lobe-sparing living-donor lobar lung transplantation (LDLLT) to overcome a small-for-size graft in standard LDLLT with acceptable results. We hypothesized that grafts implanted with this procedure might work more efficiently than those in standard lobe transplantation.MethodsBilateral LDLLT was performed in 31 patients with a functional graft matching of less than 60% at our institution between August 2008 and December 2015. Of these, 22 patients were available for evaluation of pulmonary function more than 1 year later: 15 undergoing standard LDLLT with less than 60% functional matching and 7 undergoing native upper lobe-sparing LDLLT.ResultsOverall survival at 2 years was 87.5% in the lobe-sparing LDLLT patients and 79.0% in the standard LDLLT patients (p = 0.401). The median forced vital capacity size-matching levels were 50.7% ± 1.6% in the standard LDLLT and 45.2% ± 2.3% in the sparing LDLLT group (p = 0.074). The 1-year and 2-year post-operative volume ratios of inspiration to expiration were significantly different between the 2 groups, at 1.76 and 1.45 after standard LDLLT (p = 0.019) vs 2.41 and 2.23 after lobe-sparing LDLLT (p = 0.015).ConclusionsThe grafts in lobe-sparing LDLLT functioned more effectively than those in standard LDLLT. This advantage was associated with the improvement of pulmonary functions.Copyright © 2018 Elsevier Ltd. All rights reserved.

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