Bilateral lobar lung transplantation for cystic fibrosis – first in Poland

Advances in the treatment of patients with cystic fibro­sis (CF) are progressively prolonging their lives and its quality. The median life expectancy of CF patients is now 47.7 years, whereas approximately 30 years ago it was barely 27 years of age. Still respiratory failure is the most common primary cause of death in CF patients [1]. When all other therapies fail, lung transplantation remains the only viable option to prolong survival.
Various factors may influence the outcome of the lung transplant procedure. Size matching between donor and recipient is still considered to be one of the most crucial issues and in CF patients it is taken to another level as these individuals are often malnourished. As a result, this group of patients tends to have longer waiting times for transplantation [2]. Patients in need of urgent transplantation cannot wait for size-matched organs, and therefore various methods of cadaveric donor lung downsizing have been developed and successfully applied. Basically, there are three possible methods of lung tailoring – simple wedge resection, resection outside the anatomical borders and lobar transplantation. The latter is performed when there is a large size discrepancy between donor and recipient.
In 2017, a 23-year old female patient from Poland, of blood group A, who presented with cystic fibrosis, pulmonary hypertension and oxygen-dependent respiratory failure, was referred to our unit for further evaluation of possible lung transplantation. Since 2 years she has been experiencing the increasing frequency of exacerbations requiring antibiotic therapy and hospitalization. Preoperative chest X-ray and cpmputed tomography (CT) scanning demonstrated the presence of thick-walled bronchiectasis (Figs. 1 A, B). The patient met the lung transplantation criteria according to the ISHLT guidelines [3]. An expedited work-up was completed and the ethics committee approved the procedure. On June 19, 2017, the patient underwent the transplantation procedure. The transplanted organ was acquired from a 25-year old male patient, of blood group 0, with the height of 183 cm and weight of 107 kg, diagnosed with brain death due to intracranial injury resulting from a car accident. He had no relevant medical history. To overcome the magnitude of height disparity between the donor and the recipient, bilateral transplantation of single lower lobes was performed (Fig. 2).
The operation was performed on veno-arterial extracorporeal...


View full text...