Use of over-sized mature pulmonary lower lobe grafts results in superior pulmonary function

Oliver A.R. Binns, Nuno F. DeLima, Scott A. Buchanan, Robert C. King, Jeffery T. Cope, James D. Maliszewskyj, Curtis G. Tribble, Irving L. Kron

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Background. Mature lobar transplantation will increase the pediatric donor organ pool; however, issues regarding size discrepancy between donor grafts and recipient lungs remain unresolved. We hypothesized that an over- sized mature pulmonary lobar allograft implanted into an immature recipient would provide adequate long-term pulmonary function versus a size-matched mature lobar graft or an immature whole lung. Methods. We investigated our hypothesis in a porcine orthotopic left lung transplant model in which 19 immature animals made up one control and three recipient groups. Group I underwent sham left thoracotomy (control, n = 4). Group II received age- and size-matched immature whole left lung transplant (n = 6). Group III received mature size-matched left upper lobe transplants (n = 4). Group IV received mature over-sized left lower lobe transplants (n = 5). Twelve weeks after implantation, data were collected after the native fight lung was excluded. Results. Graft weight was significantly elevated in group IV as compared with the explanted lung (72.4 ± 6.8 versus 38.3 ± 4.5 g; p = 0.003). Pulmonary artery pressure and pulmonary vascular resistance were significantly elevated in group III as compared with the over-sized mature lower lobe transplants (51.8 ± 2.2 versus 40.4 ± 2.5 mm Hg [p < 0.0001] and 1,605.9 ± 117.5 versus 857.6 ± 133.6 dynes·s·cm-5 [p < 0.0005], respectively). A trend toward decreased oxygenation was identified in group II. Conclusions. Over-sized mature lobar grafts provide improved hemodynamics as compared with size-matched grafts. Mature left lower lobe grafts are superior to size-matched upper lobe grafts in this model, probably as a result of an augmented vascular bed.

Original languageEnglish (US)
Pages (from-to)307-312
Number of pages6
JournalAnnals of Thoracic Surgery
Volume64
Issue number2
DOIs
StatePublished - Aug 1 1997
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Binns, O. A. R., DeLima, N. F., Buchanan, S. A., King, R. C., Cope, J. T., Maliszewskyj, J. D., Tribble, C. G., & Kron, I. L. (1997). Use of over-sized mature pulmonary lower lobe grafts results in superior pulmonary function. Annals of Thoracic Surgery, 64(2), 307-312. https://doi.org/10.1016/S0003-4975(97)00565-1