Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Feb 24, 2017; 7(1): 70-80
Published online Feb 24, 2017. doi: 10.5500/wjt.v7.i1.70
Lobar lung transplantation from deceased donors: A systematic review
Michael Eberlein, Robert M Reed, Mayy Chahla, Servet Bolukbas, Amy Blevins, Dirk Van Raemdonck, Alessia Stanzi, Ilhan Inci, Silvana Marasco, Norihisa Shigemura, Clemens Aigner, Tobias Deuse
Michael Eberlein, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
Michael Eberlein, Mayy Chahla, Department of Medicine, University of Iowa Hospitals and Clinics, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
Robert M Reed, Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD 21201, United States
Servet Bolukbas, Department of Thoracic Surgery, Helios Klinikum Wuppertal - University Hospital Witten/Herdecke, 42283 Wuppertal, Germany
Amy Blevins, Hardin Library for the Health Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
Dirk Van Raemdonck, Alessia Stanzi, Department of Thoracic Surgery and Lung Transplant Unit, University Hospitals Leuven, B-3000 Leuven, Belgium
Ilhan Inci, Department of Thoracic Surgery, Zurich University Hospital, 8091 Zurich, Switzerland
Silvana Marasco, Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, VIC 3004, Australia
Norihisa Shigemura, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Clemens Aigner, Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
Clemens Aigner, Department of Thoracic Surgery and Surgical Endoscopy Ruhrlandklinik, University Clinic Essen Tueschener Weg 40, 45239 Essen, Germany
Tobias Deuse, Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
Author contributions: Eberlein M, Reed RM and Chahla M contributed to conception and design; Eberlein M and Blevins A contributed to design of search strategy; Eberlein M and Chahla M contributed to study selection; Eberlein M and Deuse T contributed to writing of the manuscript; Eberlein M, Reed RM, Chahla M, Bolukbas S, Blevins A, Van Raemdonck D, Stanzi A, Inci I, Marasco S, Shigemura N, Aigner C and Deuse T contributed to revision of the manuscript.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: Not applicable.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael Eberlein, MD, PhD, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, C 33 GH, Iowa City, IA 52242, United States. michael-eberlein@uiowa.edu
Telephone: +1-319-3561265 Fax: +1-319-3536406
Received: May 30, 2016
Peer-review started: June 3, 2016
First decision: July 5, 2016
Revised: December 2, 2016
Accepted: December 27, 2016
Article in press: December 29, 2016
Published online: February 24, 2017
Processing time: 267 Days and 4.7 Hours
Abstract
AIM

To systematically review reports on deceased-donor-lobar lung transplantation (ddLLTx) and uniformly describe size matching using the donor-to-recipient predicted-total lung-capacity (pTLC) ratio.

METHODS

We set out to systematically review reports on ddLLTx and uniformly describe size matching using the donor-to-recipient pTLC ratio and to summarize reported one-year survival data of ddLLTx and conventional-LTx. We searched in PubMed, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley (CDSR), Database of Abstracts of Reviews of Effects via Wiley (DARE), Cochrane Central Register of Controlled Trials via Wiley (CENTRAL), Scopus (which includes EMBASE abstracts), and Web of Science for original reports on ddLLTx.

RESULTS

Nine observational cohort studies reporting on 301 ddLLTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The ddLLTx-group was often characterized by high acuity; however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pTLC ratio was available for 242 ddLLTx (80%). The mean pTLCratio before lobar resection was 1.25 ± 0.3 and the transplanted pTLCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddLLTx-group ranged from 50%-100%, compared to 72%-88% in the conventional-LTx group. In the largest study ddLLTx (n = 138) was associated with a lower one-year-survival compared to conventional-LTx (n = 539) (65.1% vs 84.1%, P < 0.001).

CONCLUSION

Further investigations of optimal donor-to-recipient size matching parameters for ddLLTx could improve outcomes of this important surgical option.

Keywords: Lobar lung transplantation from deceased donors; Cadaveric lobar lung transplantation; Lung size matching; Primary graft dysfunction; Survival

Core tip: Deceased-donor-lobar lung transplantation (ddLLTx) is an important and so far underutilized surgical option for lung transplant candidates with small chest cavities. It is only performed at a few specialized centers and frequently performed in high urgency cases. Outcome is acuity-driven and is expected to improve as more elective cases are done. The size matching decision for ddLLTx is complex and based on varying parameters. Systematically using the predicted Total Lung Capacity ratio as the size matching tool could help to identify sizing thresholds to maximize the risk/benefit balance for ddLLTx.