Lower lung lobe transplants
The healthy lobe from the lower part of the lung from 2 adults can be considered as a possible way to tranplant lungs from LAM patient
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Extract from http://jme.bmj.com/cgi/content/full/26/6/419
Transplantation using lung lobes from living donors
Margaret E Hodson
Royal Brompton and Harefield Hospitals, London
Margaret E Hodson, MD, MSc, FRCP, DA, is Professor of Respiratory Medicine and Honorary Consultant Physician, Royal Brompton and Harefield Hospitals, Sydney Street, London SW3 6NP.
At present, in the UK, live lobe donation of the lung is generally considered in the context of patients with cystic fibrosis (CF) which is a life-threatening, inherited disease.1 However, if this technique is successfully developed it may be applicable to other patients with end stage lung disease. Cystic fibrosis is a disease where the major morbidity and mortality is due to pulmonary infection and respiratory failure.2 In l938 70% of patients born with CF died within one year of birth, but now the average survival has improved to 32 years.1 The improved survival has been due to improved medical care, but also, and in very large measure, to the devotion of the families who have carried out time-consuming daily treatments such as chest physiotherapy, nebuliser treatment, high calorie diets etc. To these patients and their families lung transplantation brought new hope.3 The first successful transplant for CF was performed in the UK in 1985 and we now have patients alive and well more than ten years after transplantation. However, sadly, nearly 50% of patients with CF die on the transplant waiting list because of a shortage of donor organs from brain stem dead donors. This is a tragedy for the individual patient, the families and those who care for them. Is there a way forward?
Living lobe donation for patients with CF
The first successful transplant using lobes from living donors was carried out by Professor Starnes in the USA.45 In 1996 he reported a 75% one-year survival rate for 20 CF patients who had had lung transplants from living lobe donors. This is a similar rate to that for conventional transplantation. There were no reports of mortality in the donors. The major advantage of a living lobe transplantation for patients with CF is that the patient gets a transplant instead of a 50% chance of dying on the waiting list. It is likely that about 25% of patients with CF have family members who are willing and able to donate organs. Humans have five lung lobes and the patient receives one lower lobe from each of two donors. The donor is left with four lung lobes. The recipient has both his/her diseased lungs removed and receives two new lung lobes, one from each of two donors. However, the lung function of these recipients at two years is comparable with those receiving conventional transplantation from a brain stem dead donor with five lobes. The tissue transplanted from a living donor is deprived of its blood supply for a shorter period of time than when a brain stem dead donor is used. In the latter situation there is always delay, sometime of three to four hours, while the tissue is being transported from the donor hospital to the recipient. The use of lobes from a living donor also has the advantage that the operation can be done electively during the day, not in the middle of the night as an emergency, as so often happens with transplants from brain stem dead donors. Patients who receive genetically related transplants also appear to have fewer problems with obliterative bronchiolitis. This is a condition which causes a lot of morbidity in patients receiving conventional lung transplantation and it is thought to be a form of chronic rejection of the transplanted tissue.