Technique of Successful Clinical Double-Lung Transplantation

doi:10.1016/S0003-4975(10)64763-7

The Annals of Thoracic Surgery

Volume 45, Issue 6, June 1988, Pages 626-633

https://doi.org/10.1016/S0003-4975(10)64763-7 Get rights and content

Abstract

Lung transplantation has become a successful method in the therapy for end-stage pulmonary disease. While single-lung transplantation provides benefit to patients with pulmonary fibrosis, bilateral lung transplants are required for septic or emphysematous lung disease. We describe the technique employed in 6 patients to transplant en bloc both lungs with the recipient heart left in place. The lungs are connected by a left atrial cuff, main pulmonary artery, and trachea. The completed implantation has a tracheal anastomosis securely wrapped in omentum, a left atrial anastomosis posterior to the heart, and a pulmonary artery anastomosis anteriorly. Airway ischemia resulted in the death of 1 patient. This procedure allows complete excision of all diseased pulmonary tissue, retention of the recipient's own heart, and separate excision of the donor heart for use in another recipient, thereby markedly increasing the supply of donor lungs for transplantation.

References (13)

JD Cooper et al.
Technique of successful lung transplantation in humans
J Thorac Cardiovasc Surg
(1987)
BP Griffith et al.
Heart-lung transplantation: lessons learned and future hopes
Ann Thorac Surg
(1987)
JH Dark et al.
Experimental en bloc double-lung transplantation
Ann Thorac Surg
(1986)
GT Christakis et al.
Right ventricular dysfunction following cold potassium cardioplegia
J Thorac Cardiovasc Surg
(1985)
JC Mullen et al.
Right ventricular function: a comparison between blood and crystalloid cardioplegia
Ann Thorac Surg
(1987)
SW Jamieson et al.
Operative technique for heart-lung transplantation
J Thorac Cardiovasc Surg
(1984)

There are more references available in the full text version of this article.

Cited by (215)

Therapeutic benefits of nitric oxide in lung transplantation
2023, Biomedicine and Pharmacotherapy
Lung transplantation is an evolutionary procedure from its experimental origin in the twentieth century and is now recognized as an established and routine life-saving intervention for a variety of end-stage pulmonary diseases refractory to medical management. Despite the success and continuous refinement in lung transplantation techniques, the widespread application of this important life-saving intervention is severely hampered by poor allograft quality offered from donors-after-brain-death. This has necessitated the use of lung allografts from donors-after-cardiac-death (DCD) as an additional source to expand the pool of donor lungs. Remarkably, the lung exhibits unique properties that may make it ideally suitable for DCD lung transplantation. However, primary graft dysfunction (PGD), allograft rejection and other post-transplant complications arising from unavoidable ischemia-reperfusion injury (IRI) of transplanted lungs, increase morbidity and mortality of lung transplant recipients annually. In the light of this, nitric oxide (NO), a selective pulmonary vasodilator, has been identified as a suitable agent that attenuates lung IRI and prevents PGD when administered directly to lung donors prior to donor lung procurement, or to recipients during and after transplantation, or administered indirectly by supplementing lung preservation solutions. This review presents a historical account of clinical lung transplantation and discusses the lung as an ideal organ for DCD. Next, the author highlights IRI and its clinical effects in lung transplantation. Finally, the author discusses preservation solutions suitable for lung transplantation, and the protective effects and mechanisms of NO in experimental and clinical lung transplantation.
Current and future role of double-lung transplantation for bilateral lung cancer
2023, Transplantation Reviews
Technological advances have progressively enhanced the survival rate of lung transplant recipients and expanded its indications for various diseases, including the recent coronavirus disease 2019 (COVID-19). However, according to the International Society for Heart and Lung Transplantation, lung cancer constituted a mere 0.1% of the indications for lung transplantation over the past two decades. This statistic has remained stagnant, and numerous lung cancer patients continue to be excluded from lung transplantation candidacy. Contrary to the general exclusion of lung cancer patients from transplantation, the post-transplant survival rate for these patients is not inferior to that of patients with non-cancerous diseases. Furthermore, lung transplantation may offer curative treatment for patients with bilateral lung cancer whose respiratory insufficiency has advanced independently of cancer progression. This review aims to elucidate and examine the role of double lung transplantation (DLT) in bilateral lung cancer. We summarize the established indications for lung transplantation, appropriate histologic or molecular subtypes of lung cancer for transplantation, technical advances to minimize recurrence, post-DLT survival outcomes for lung cancer patients, and related translational research. We suggest that although DLT for bilateral lung cancer presents challenges, it may be considered a potential treatment option in select circumstances.
History of Lung Transplantation
2023, Clinics in Chest Medicine
Cardiopulmonary bypass in lung transplantation
2022, Cardiopulmonary Bypass: Advances in Extracorporeal Life Support
The use of cardiopulmonary bypass (CPB) was necessary for the early success of lung transplantation. In more recent years, the rate of utilization has decreased due to advances in surgical technique and the rising utilization of intraoperative extracorporeal membrane oxygenation (ECMO). This chapter will focus on the use of CPB specifically in the setting of lung transplantation. Surgical approaches and cannulation strategies will be discussed for both single and bilateral lung transplantations. Furthermore, specific scenarios in which CPB is particularly advantageous will be discussed along with a review of published outcomes for lung transplants performed using CPB. Finally, the option of hybrid CPB/ECMO setups will be reviewed.
Lung transplantation as standard of care for advanced cystic fibrosis lung disease
2020, Journal of Heart and Lung Transplantation
Experience from an American Association for Thoracic Surgery Foundation for Thoracic Surgery Training Fellowship: Lung transplantation in Toronto General Hospital
2018, Journal of Thoracic and Cardiovascular Surgery

View all citing articles on Scopus

: Presented at the Twenty-third Annual Meeting of The Society of Thoracic Surgeons, Toronto, Ont, Canada, Sept 21–23, 1987.

View full text

Technique of Successful Clinical Double-Lung Transplantation

Abstract

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg