Oversized Lobar Lung Allografts Might Be an Option For Transplantion in Children

After a two year follow up of a lobar lung transplant in a pediatric patient, it was concluded that adult allograft might be a viable source for lung transplant. The donor was the parent of the patient, and since this was a lobar transplant, the donor was left with enough lung volume to have a normal live. Although the lung allograft was 180% of the size it was supposed to be for the recipient, the patient was able to breath on his own only 10 days after surgery. After surgery, the allograft showed to be 47% of its original volume and presented partial atelectasis. Despise this, the transplanted lung functioned started functioning perfectly after the post-op. As the recipient grew, the lung allograft responded to the change in size by gradually recovering part of its original volume. At the same time, the pulmonary function improve in almost a linear fashion when related to the volume "re-increase."

Researchers do not completely understand why this happens, but it might be due to the fact that the structures in the thoracic cavity are more flexible during early childhood. It is also pointed that although the procedure had been successful, it is not certain that the allograft (a single lobe transplant) will provide enough respiratory as the subject becomes an adult. In that case, the patient might need a bilateral lung transplant (basically both lungs from someone else) from a brain-dead donor.

I thought the case they presented in article was very interesting, as it goes back to a discussion in our class had about lung transplants. This lobar transplants seem to be an acceptable alternative for pediatric patients, since it might be difficult to find donors for a bilateral transplant in these cases. Even if the allograft eventually start failing, enough time would have passed, and there might a donor for bilateral lung transplant.

Source:

http://icvts.ctsnetjournals.org/cgi/rapidpdf/icvts.2010.249870v1