Kadavradan Lober Akciğer Nakli: Türkiye’de İlk Deneyimler

Giriş: Akciğer nakli, son dönem akciğer hastalıkları için son tedavi seçeneğidir. Donör havuzunun azlığı, bekleme listesi ölümlerinin başlıca nedenidir. Donör havuzu azlığının üstesinden gelmek için lober akciğer nakli önerilmiştir. Bu çalışmada, lober akciğer nakli yapılan hastalar ile ilgili ilk deneyimimiz sunulmuştur. Hastalar ve Yöntem: Bu tek merkezli retrospektif çalışma, akciğer nakli merkezimizde Aralık 2016-Aralık 2018 tarihleri arasında kadavra lober akciğer nakli yapılan hastaları içermektedir. Bu prosedür sadece acil durumu olan hastalarda uygulanmıştır. Bulgular: Çalışma dönemindeki 55 akciğer naklinden altısı [%10.9; dördü kadın, ikisi erkek; medyan yaş 35.3 yıl (aralık, 22-42 yaş)] lober akciğer nakli idi. Endikasyonlar bronşektazi (üç hasta), kronik obstrüktif akciğer hastalığı (bir hasta), kistik akciğer hastalığı (bir hasta) ve lepidik tip adenokarsinom (bir hasta) idi. İki hastada bilateral lober akciğer, iki hastada sağ tek akciğer ve sol alt lob, iki hastada sol tek akciğer ve sağ alt lob akciğer nakli idi. Bir yıllık mortalite %16.6 (1/6) idi. Akciğer naklinden sonra 23. ve 24. ayda iki hasta ölmüştür. Üç hasta halen hayattadır (24, 25 ve 47. aylarda). Sonuç: Lober akciğer nakli, donör eksikliğinin üstesinden gelmek için küçük göğüs boşlukları olan kritik hastalarda hayat kurtarıcı bir tedavi seçeneği olabilir. Aynı zamanda, tek taraflı göğüs boşluğu azalmış alıcılarda uygulanabilir bir ameliyat tekniğidir.

Initial Experience with Cadaveric Lobar Lung Transplantation in Turkey

Introduction: Lung transplantation is the final treatment option for end-stage lung diseases. A scarce donor pool is the primary cause of waiting list mortality. Lobar lung transplantation has been proposed to overcome the donor pool shortage. Herein we present our initial experience with patients who underwent lobar lung transplantation. Patients and Methods: This single-center retrospective study included patients who underwent cadaveric lobar lung transplantation between December 2016 and December 2018 at our Lung Transplant Center. The procedure was performed only in patients with an emergency status. Results: Of the 55 lung transplants during the study period, six [10.9%; four female, two male; median age, 35.3 years (range, 22-42 years)] were lobar lung transplants. The indications were bronchiectasis (three patients), chronic obstructive pulmonary disease (one patient), cystic lung disease (one patient), and lepidic type adenocarcinoma (one patient). The transplantations included bilateral lobar lung in two patients, the right single lung and the left lower lobe in two patients, and the left single lung and the right lower lobe in two patients. One-year mortality was 16.6% (1/6). Two patients died 23 and 24 months after lung transplantation. Three patients were alive at the last follow-up (at 24, 25, 47 months). Conclusion: Lobar lung transplantation can be a life-saving treatment option in critically ill patients with small thoracic cavities to overcome donor shortage. Furthermore, it is a feasible operative technique in recipients with a reduced unilateral thoracic cavity.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi