Donor directed lobar lung transplantation

摘要

Lung transplantation remains the gold standard surgical treatment for patients with end-stage lung failure from a variety of causes; however for the foreseeable future, will continue to be a limited modality, secondary to a critical shortage of suitable donor organs ( ). Living lobar lung transplantation, a technique pioneered by Dr. Vaughn Starnes at the University of Southern California (USC), involves locating two donors per recipient and harvesting a lobe from each for implantation. This strategy reached its peak popularity in the late 1990’s in the United States with several centers, notably USC and Washington University in St. Louis, reporting favorable outcomes for donor-directed lobar lung transplantation ( ). The implementation of the lung allocation score (LAS) ( ) in 2005 catalyzed a drastic change in the way organs are matched to recipients, moving away from the previous time-based system on the transplant waiting list and towards a system that prioritized critically ill patients ( ). This allocation strategy has led to a decrease in waitlist mortality and an increase in the overall number of transplants performed in the United States ( ). Additionally, along with improved medical management options for certain lung diseases, donor-directed lobar transplantation has steadily decreased in frequency.