Differences in chronic lung allograft dysfunction between deceased-donor lung transplantation and living-donor lobar lung transplantation

Satona Tanaka; Mamoru Takahashi; Hidenao Kayawake; Yojiro Yutaka; Akihiro Ohsumi; Daisuke Nakajima; Kohei Ikezoe; Kiminobu Tanizawa; Tomohiro Handa; Hiroshi Date

doi:10.1016/j.jtcvs.2024.10.004

Differences in chronic lung allograft dysfunction between deceased-donor lung transplantation and living-donor lobar lung transplantation

J Thorac Cardiovasc Surg. 2024 Oct 10:S0022-5223(24)00913-9. doi: 10.1016/j.jtcvs.2024.10.004. Online ahead of print.

Affiliations

¹ Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan. Electronic address: satonat@kuhp.kyoto-u.ac.jp.
² Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
³ Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁴ Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

PMID: 39393626
DOI: 10.1016/j.jtcvs.2024.10.004

Abstract

Objective: To explore the characteristics and prognostic impact of chronic lung allograft dysfunction (CLAD) after deceased-donor lung transplantation and living-donor lobar lung transplantation, wherein the lower lobes from 2 donors are usually transplanted into one recipient.

Methods: The clinical data of 123 deceased-donor and 67 living-donor lung transplantations performed in adult patients at our institution between June 2008 and September 2019 were retrospectively reviewed. The cumulative incidence of CLAD was evaluated on a per-recipient and per-donor graft basis using the Kaplan-Meier method.

Results: A smaller number of human leukocyte antigen mismatches, shorter ischemic time, and lower incidence of grade 3 primary graft dysfunction were observed in living-donor transplantation than in deceased-donor transplantation (P < .001). Restrictive allograft syndrome-type CLAD occurred in 9 (20.9%) of 43 patients with CLAD after deceased-donor transplantation and 9 (45.0%) of 20 patients with CLAD after living-donor transplantation. CLAD occurred unilaterally in 15 patients (75.0%) after bilateral living-donor transplantation. Despite the greater incidence of restrictive allograft syndrome-type CLAD after living-donor transplantation, the overall survival rates after the transplantation and survival rates after the onset of CLAD were comparable between the patients receiving deceased-donor transplants and living-donor transplants. The cumulative incidence of CLAD per recipient was similar between recipients of deceased-donor and the living-donor transplants (P = .32). In the per-donor graft analysis, the cumulative incidence of CLAD was significantly lower in the living-donor grafts than in the deceased-donor grafts (P = .003).

Conclusions: The manifestation of CLAD after living-donor lobar lung transplantation is unique and differs from that after deceased-donor lung transplantation.

Keywords: bronchiolitis obliterans syndrome; chronic lung allograft dysfunction; deceased-donor lung transplantation; human leukocyte antigen; living-donor lobar lung transplantation; restrictive allograft syndrome.