# Living-donor Lobar Lung Transplantation - Initiation and Development - Secondary Publication

## TL;DR

A pioneering lung transplant technique using living donors has been developed and improved over 25 years, showing better survival rates than traditional donor transplants.

## Contribution

The development and refinement of living-donor lobar lung transplantation techniques, including ABO-incompatible transplants and new surgical approaches.

## Key findings

- A patient who received a living-donor lobar lung transplant in 1998 remains alive and healthy 25 years later.
- Survival rates after living-donor lobar lung transplantation (83%) are higher than cadaveric lung transplantation (74%).
- New LDLLT techniques like right-to-left inverted and segmental lung transplantation have been developed to address size mismatches.

## Abstract

Due to the difficulty of finding brain-dead donors, in October 1998, I performed the first living-donor lobar lung transplantation (LDLLT) for a ventilator-dependent 24-year-old female patient with bronchiectasis using lobes from her parents. The patient is still alive and in good health 25 years after the transplantation. Over time, the indications for LDLLT have expanded to include pulmonary hypertension, pulmonary fibrosis, congenital genetic diseases, pulmonary complications after stem cell transplantation, and, more recently, severe lung injury due to COVID-19 infection. In 2022, we successfully performed an ABO-incompatible LDLLT. To address size mismatches, we have developed new LDLLT techniques, such as right-to-left inverted transplantation, upper lobe-sparing transplantation, and segmental lung transplantation. Our published studies cover a range of topics, encompassing both basic and clinical research. Of particular significance is the observation that LDLLT offers immunological advantages over cadaveric lung transplantation (CLT). Having conducted 353 cases of lung transplantation, including 161 LDLLTs and 192 CLTs, our 5-year survival rates were 83% after LDLLT and 74% after CLT, surpassing the 55% 5-year survival rate reported by the International Society for Heart and Lung Transplantation. We have hosted numerous observers and research fellows from 15 countries. In addition, I have contributed to LDLLT procedures not only in Japan but also abroad. It brings me great satisfaction to think that my educational efforts may ultimately lead to saving the lives of those suffering from end-stage respiratory failure around the world.