Reduced-size lung transplantation from adult to neonatal swine

BACKGROUND: Lung donor shortage is a critical factor limiting the expansion of pediatric lung transplantation programs. This report details the surgical technical feasibility of a training model of lobar lung transplantation as well as the perioperative monitoring to evaluate the appropriate pulmonary graft function. METHODS: Ten hybrid Large-White pigs underwent left lower lobe lung allotransplantation; Donors weighed 15 to 20 kg and recipients 5 to 7 kg. The first five animals were used to learn the surgical anatomy and to establish the surgical technique and instrumentation's model (Group A). One hour after transplantation the right lung was excluded. Lung function and hemodynamic data were collected sequentially in the following five animals (Group B). RESULTS: The left inferior pulmonary lobe was found to be the most suitable allograft for transplantation. Usually, bronchial size discrepancy allowed telescoping of the airway anastomosis. Left atrial clamping was well tolerated during the pulmonary vein anastomoses. Preoperative antiaggregation and postoperatively heparinization achieved with ACT values over 200 seconds, prevented left atrial thrombosis. After right lung exclusion, hemodynamic changes consisted of a sustained increase in pulmonary vascular resistance and a reduction in cardiac output. Lung mechanics were also modified, with a gradual rise in airway resistance and a fall in compliance. CONCLUSIONS: The neonatal pig tolerates left lobar pulmonary transplantation satisfactorily. Although it is a useful and promising surgical learning model, questions remain regarding the applicability of this experience to clinical pediatric lung transplantation.