Delayed Chest Closure in Adult Living-donor Lobar Lung Transplantation—A Case Report

Delayed chest closure (DCC) is a useful technique in cases with oversized lung grafts, pulmonary edema, and hemodynamic instability. Anatomically oversized lung grafts are potentially problematic in pediatric living-donor lobar lung transplantation (LDLLT), but rarely in an adult LDLLT. We experienced a case of anatomically oversized grafts in the adult LDLLT requiring DCC, although the grafts provided only 57.2% of the recipient's predicted forced vital capacity. Through 3-dimensional computed tomography volumetry, the volume of the donor's right lower lobe was illustrated as 108% of that of the recipient's right hemithorax, the volume of the donor left lower lobe was 143% of that of the recipient's left hemithorax. Her chest was closed without volume reduction 5 days after transplantation. Our experience illustrates the importance of anatomical size-matching even in an adult LDLLT and the usefulness of DCC as a perioperative management modality.