Chest ACCP Member Benefits
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (3)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Date, H.
Right arrow Articles by Shimizu, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Date, H.
Right arrow Articles by Shimizu, N.
(Chest. 2005;128:1364-1370.)
© 2005 American College of Chest Physicians

A New Treatment Strategy for Advanced Idiopathic Interstitial Pneumonia*

Living-Donor Lobar Lung Transplantation

Hiroshi Date, MD; Yasushi Tanimoto, MD; Keiji Goto, MD; Ichiro Yamadori, MD; Motoi Aoe, MD; Yoshifumi Sano, MD and Nobuyoshi Shimizu, MD

From the Departments of Cancer and Thoracic Surgery (Drs. Date, Aoe, Sano, and Shimizu), Pulmonary Medicine (Dr. Tanimoto), and Anesthesiology and Resuscitology (Dr. Goto), Okayama University Graduate School of Medicine and Dentistry; and Department of Pathology (Dr. Yamadori), National Hospital Organization Okayama Medical Center, Okayama, Japan.

Correspondence to: Hiroshi Date, MD, Department of Cancer and Thoracic Surgery (Surgery II), Okayama University Graduate School of Medicine and Dentistry, 2–5-1 Shikata-Cho, Okayama 700-8558, Japan; e-mail: hdate{at}nigeka2.hospital.okayama-u.ac.jp

Background: Among patients awaiting cadaveric lung transplantation, patients with idiopathic interstitial pneumonia (IIP) have been demonstrated to have the highest mortality rate. Contraindications to cadaveric lung transplantation include current high-dose systemic corticosteroid therapy because it may increase airway complications and various types of infection.

Study objectives: To analyze the effect of living-donor lobar lung transplantation (LDLLT) for patients with advanced IIP including those receiving high-dose systemic corticosteroids.

Design: Retrospective analysis.

Setting: Okayama University Hospital and Okayama Medical Center.

Patients: We report on the first nine patients (seven female and two male; age range, 13 to 55 years) with advanced IIP receiving LDLLT. All nine patients had a very limited life expectancy, and eight patients were dependent on systemic corticosteroid therapy as high as 50 mg/d of prednisone. LDLLT was performed under cardiopulmonary bypass using two lower lobes donated by two healthy relatives.

Results: There were no airway complications in the 18 bronchial anastomoses. There was one early death (11%) due to severe acute rejection. Eight patients (89%) are currently alive with a follow-up period of 10 to 48 months. Their vital capacity reached 2.03 ± 0.20 L (mean ± SEM), 71.4% of predicted at 1 year. All 18 donors have returned to their previous lifestyles. Excised lungs were pathologically diagnosed as usual interstitial pneumonia (UIP) in six cases and fibrotic nonspecific interstitial pneumonia (NSIP) in three cases.

Conclusions: These early follow-up data support the option of LDLLT in patients with advanced IIP, including UIP and fibrotic NSIP, who would die soon otherwise. Current high-dose systemic corticosteroid therapy is not a contraindication in LDLLT.

Key Words: idiopathic interstitial pneumonia • idiopathic pulmonary fibrosis • living-donor lobar lung transplantation • nonspecific interstitial pneumonia • usual interstitial pneumonia






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2005 by the American College of Chest Physicians.