SESSION TITLE: Transplantation Case Report Poster
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM
INTRODUCTION: Lung transplant patients face a scarcity of suitable organ donors, leading to prolonged waiting times and increased waiting list morbidity and mortality. Bilateral Cadaveric Lobar Lung Transplantation (BCLLT) can expand the donor pool in cases where donors may be unsuitable for whole lung donation due to viability of the lower lobes and yet have upper lobes suitable for transplantation in patients of small stature or reduced pleural space. To the best of our knowledge, this is the first reported case of BCCLT in the UK.
CASE PRESENTATION: A 13-year old boy with advanced cystic fibrosis (CF) diagnosed in childhood (ΔF508/2622+1G->A splicing mutation) was referred for urgent transplantation with severe and rapidly progressive lung disease. He had been on an active transplant list for three years during which he experienced a progressive deterioration in his clinical status and quality of life with frequent hospitalizations for severe recurrent lower respiratory tract infections. A persistent decline in lung function rendered him oxygen and BiPAP-dependent for 18 months prior to transplantation and he was functionally wheelchair-bound. His clinical state remained increasingly precarious with the development of ventilation-refractory hypercapnia and respiratory acidosis. He was ‘super-urgently’ listed for size-matched BCLLT using the upper lobes of a cadaveric adult donor. CMV mismatch was treated with prophylactic valganciclovir. The surgical procedure was uneventful and he was discharged home after 5 weeks. Transbronchial biopsies at two and eight weeks post-transplant showed mild acute rejection which were treated with steroid augmentation.
DISCUSSION: This technique using cadaveric lungs has been utilized in several centres worldwide including Vienna, Melbourne, Switzerland and more recently, America. A small percentage of these procedures were performed in children with end stage CF. Reports on the collective experience in these centres suggest that BCCLT has 1 and 5-year survival rates comparable with standard bilateral whole lung transplantation and should therefore be considered in selected candidates.
CONCLUSIONS: Clearly this is a single case report with short term follow-up but we believe this case demonstrates that innovative techniques, utilized selectively, can produce excellent results for patients who may not otherwise survive the prolonged transplant waiting time for donor lungs of suitable size.
Reference #1: Marasco SF, Than S, Keating D, Westall G, Whitford H, Snell G, et al. Cadaveric lobar lung transplantation: Technical aspects. Ann Thorac Surg 2012; 93:1836-1842.
Reference #2: Inci I, Schuurmans MM, Kestenholz K, Schnieter D, Hillinger S, Opitz I, et al. Long-term outcomes of bilateral lobar lung transplantation. Eur J Cardiothorac Surg 2013; 43(6):1220-1225.
Reference #3: Shigemura N, D’Cunha J, Bhama JK, Shiose A, Abou El Ela A, Hackmann A, et al. Lobar lung transplantation: a relevant surgical option in the current era of lung allocation score. Ann Thorac Surg 2013; 96(2):451-456.
DISCLOSURE: The following authors have nothing to disclose: Melissa McDonnell, Asif Hasan, Malcolm Brodlie, Christopher O'Brien, David Spencer, Dubhfeasa Slattery, Jim Egan, Richard Kirk, Jim Lordan
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