Right-to-Left Inverted Living-Donor Lobar Lung Transplantation

Abstract

In standard bilateral living-donor lobar lung transplantation (LDLLT), right and left lower lobes donated by 2 healthy donors are implanted into a recipient after right and left pneumonectomies. Because only 2 lobes are implanted, the grafts may be too small for an adult recipient. To overcome size mismatch, we have developed a technique of right-to-left inverted LDLLT based upon the fact that the right lower lobe is generally larger than the left lower lobe. In right-to-left inverted LDLLT, 2 donors donate their right lower lobes. The right graft is implanted in the right side of the recipient. The left graft is inverted and implanted in the left side. This operation is indicated when total graft forced vital capacity (FVC) is less than 60% of the recipient's predicted FVC or when donor's left lower lobectomy is technically difficult due to interlobar pulmonary artery anatomy.