Postoperative pulmonary function and complications in living-donor lobectomy

Fengshi Chen, Tetsu Yamada, Masaaki Sato, Akihiro Aoyama, Akihiro Takahagi, Toshi Menju, Toshihiko Sato, Makoto Sonobe, Mitsugu Omasa, Hiroshi Date
Journal of Heart and Lung Transplantation 2015, 34 (8): 1089-94

BACKGROUND: Successful living-donor lobar lung transplantation largely depends on the donor's outcome. Because surgical skills and peri-operative management have evolved over time, this study evaluated the recent outcomes of donor lobectomies.

METHODS: Between 2008 and 2014, 48 consecutive living-donor lobar lung transplantations with 85 donor lobectomies were performed at Kyoto University. All donors were prospectively followed up regularly until 1 year after surgery.

RESULTS: Right and left lower lobectomies were performed in 49 and 36 donors, respectively. Pulmonary arterial branches were sacrificed at equal frequency in both lobectomies, whereas pulmonary arterioplasty was only performed in left lower lobectomy (n = 9). All donors were discharged after the lobectomies, and none died during follow-up. Post-operative complications occurred in 24 donors (28%) overall, without a significant difference between donor sides. Intraoperative complications were found in 2 donors. Early and late post-operative complications were noted in 17 and 6 donors, respectively. Pneumothorax, pleuritis, and pleural effusion were the most frequent. Post-operative pulmonary function sequentially recovered more than expected and was not significantly affected by the sacrifice of pulmonary arterial branches during lobectomy. By contrast, pulmonary function at 1 year after donor lobectomy in the donors who had peri-operative complications was significantly lower than that in the donors who did not, although even post-operative pulmonary function in the donors with peri-operative complications still recovered more than expected.

CONCLUSIONS: Living-donor lobectomies have been safely performed in recent decades with low morbidities and without mortality.

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