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• W2004996504 abstract "PurposeSurgical strategy for short patients with restrictive pulmonary pathology remains challenging. These recipients traditionally receive pediatric size lungs, placing an additional strain on already restricted pediatric donor population. Performing lobar lung transplantation (LLT) can circumvent issues with donor-recipient size mismatch; however, LLT has additional risks that are not experienced in standard LT. Here, we review our experience using LLT and standard lung transplant using pediatric donor lungs (PDLT) for small adult chests.MethodsWe retrospectively reviewed patients with end-stage lung diseases and a height < 65 inches who underwent LLT (n=15) or PDLT (n=15) between 2006 and 2012 at our institution, a high-volume lung transplant center.ResultsAll recipients underwent double lung transplants. LLT recipients were older than PDLT recipients (54±10 vs 48±8 years). Furthermore, LLT recipients had higher pulmonary pressures (57±11 vs 52±27mmHg) and higher lung allocation scores (70±9 vs 51±8) compared to PDLT recipients, reflecting a sicker population which could not wait a long time to be transplanted: waiting time was 62 days for PDLT and 9 days for LLT. The incidence of severe PGD requiring ECMO support and acute renal insufficiency was higher, and intensive care unit stay was longer in the LLT group (p<0.05), whereas the incidence of bronchial anastomotic complications was higher in the PDLT group due to significant size discrepancy in their main bronchus (p<0.05). Interestingly, long-term functional outcomes were similar between the groups.ConclusionBoth LLT and PDLT are viable surgical options for the patients with small adult chests. Considering for all their potential positive and negative impacts on posttransplant outcomes as well as technical complexity, the decisions must be made by experienced surgeons. PurposeSurgical strategy for short patients with restrictive pulmonary pathology remains challenging. These recipients traditionally receive pediatric size lungs, placing an additional strain on already restricted pediatric donor population. Performing lobar lung transplantation (LLT) can circumvent issues with donor-recipient size mismatch; however, LLT has additional risks that are not experienced in standard LT. Here, we review our experience using LLT and standard lung transplant using pediatric donor lungs (PDLT) for small adult chests. Surgical strategy for short patients with restrictive pulmonary pathology remains challenging. These recipients traditionally receive pediatric size lungs, placing an additional strain on already restricted pediatric donor population. Performing lobar lung transplantation (LLT) can circumvent issues with donor-recipient size mismatch; however, LLT has additional risks that are not experienced in standard LT. Here, we review our experience using LLT and standard lung transplant using pediatric donor lungs (PDLT) for small adult chests. MethodsWe retrospectively reviewed patients with end-stage lung diseases and a height < 65 inches who underwent LLT (n=15) or PDLT (n=15) between 2006 and 2012 at our institution, a high-volume lung transplant center. We retrospectively reviewed patients with end-stage lung diseases and a height < 65 inches who underwent LLT (n=15) or PDLT (n=15) between 2006 and 2012 at our institution, a high-volume lung transplant center. ResultsAll recipients underwent double lung transplants. LLT recipients were older than PDLT recipients (54±10 vs 48±8 years). Furthermore, LLT recipients had higher pulmonary pressures (57±11 vs 52±27mmHg) and higher lung allocation scores (70±9 vs 51±8) compared to PDLT recipients, reflecting a sicker population which could not wait a long time to be transplanted: waiting time was 62 days for PDLT and 9 days for LLT. The incidence of severe PGD requiring ECMO support and acute renal insufficiency was higher, and intensive care unit stay was longer in the LLT group (p<0.05), whereas the incidence of bronchial anastomotic complications was higher in the PDLT group due to significant size discrepancy in their main bronchus (p<0.05). Interestingly, long-term functional outcomes were similar between the groups. All recipients underwent double lung transplants. LLT recipients were older than PDLT recipients (54±10 vs 48±8 years). Furthermore, LLT recipients had higher pulmonary pressures (57±11 vs 52±27mmHg) and higher lung allocation scores (70±9 vs 51±8) compared to PDLT recipients, reflecting a sicker population which could not wait a long time to be transplanted: waiting time was 62 days for PDLT and 9 days for LLT. The incidence of severe PGD requiring ECMO support and acute renal insufficiency was higher, and intensive care unit stay was longer in the LLT group (p<0.05), whereas the incidence of bronchial anastomotic complications was higher in the PDLT group due to significant size discrepancy in their main bronchus (p<0.05). Interestingly, long-term functional outcomes were similar between the groups. ConclusionBoth LLT and PDLT are viable surgical options for the patients with small adult chests. Considering for all their potential positive and negative impacts on posttransplant outcomes as well as technical complexity, the decisions must be made by experienced surgeons. Both LLT and PDLT are viable surgical options for the patients with small adult chests. Considering for all their potential positive and negative impacts on posttransplant outcomes as well as technical complexity, the decisions must be made by experienced surgeons." @default.
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• W2004996504 date "2015-04-01" @default.
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• W2004996504 title "Surgical Strategy for Small Adult Chests in Lung Transplantation: Lobar vs. Standard Using a Pediatric Donor" @default.
• W2004996504 doi "https://doi.org/10.1016/j.healun.2015.01.690" @default.
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