Current Status and Problems of Living-donor Lobar Lung Transplantation

Living-donor lobar lung transplantation (LDLLT) has become an important life-saving option for patients with severe respiratory disorders in order to address the current severe shortage of brain-dead donor organs. Although LDLLT candidates were basically limited to critically ill patients who would require hospitalization, the long-term use of steroids, and/or mechanical respiratory support before transplantation, LDLLT provided good post-transplant outcomes, comparable to brain-dead donor lung transplantation( BDLT). In Kyoto University, the 1-, 5- and 10-year survival rates were 91%, 79% and 62% after LDLLT and 92%, 72% and 65% after BDLT, respectively. Various transplant procedures have recently been developed in LDLLT in order to deal with the issue of graft size mismatching. Native upper lobe-sparing and/or right-to-left inverted transplantation have been performed for undersized grafts, while single-lobe transplantation has been employed for oversized grafts. These new transplant procedures have provided favorable post-transplant outcomes.