Outcome of lung volume reduction for oversized donors during pulmonary transplantation

Objective: Lung transplant patients were reviewed to examine the effect and outcome of Lung Graft Volume Reduction (LGVR) after pulmonary transplantation with oversized donor lungs. Methods: A 10 year retrospective review of all single and bilateral lung transplant patients was performed. Patients who underwent LGVR for oversized grafts during pulmonary transplantation were identified and reviewed. Results: 13 patients underwent LGVR during pulmonary transplantation from a total of 468 recipients (2.6%). There were 9 bilateral, 1 re-do bilateral and 3 single lung recipients who received oversized donor organs and required LGVR during implantation. Recipients included (6 males) with a mean age 40 years (range, 16-64 years). Preoperative diagnoses included cystic fibrosis (4), fibrotic lung disease (4), COPD (2), primary pulmonary hypertension (1) and extrinsic allergic alveolitis (1). Donor lungs were oversized by a mean of 16% of the recipient predicted total lung capacity and 51.5% of the recipient measured total lung capacity. LGVR was carried out using linear cutting staplers in the form of bilateral apical segmentectomy in 2 cases, lingulectomy in 5 cases and multiple wedge resections of all lobes in 7 cases. 4 patients underwent formal pulmonary lobectomy. The median extubation time was 1.5 (1-21) days. One died whilst on the ventilator (24 days). The median ITU stay was 6.5 (2-56) days. 3 (25%) patients died at a mean duration of 2.3 months (range 1-5 months). 8 patients (66.67%) remain alive at a mean duration of 38 months (range 10-74 months). Conclusion: LGVR in an oversized pulmonary graft is an acceptable procedure for patients undergoing lung transplantation. In our experience LGVR is associated with good outcomes in the short and long term. Surgeons should always give consideration to using lung grafts oversized for the recipient