Journal of Advanced Therapeutic Science

Journal of Advanced Therapeutic Science

Current Issue Volume No: 1 Issue No: 1

Case-report Article Open Access
  • Available online freely Peer Reviewed

  • The Initial Result Of The First Living Donor Lung Transplantation Case In Vietnam

    Q Do 1     Viet T Tran 2     Manh A Hoang 2     Truong G Nguyen 2     Huy L Nguyen 2     Ba T Ta 2
       

    1 Vietnam Military Medical University 

    2 103 Military Hospital 

    Abstract

    Lung transplantation is an established treatment option for patients of end-stage lung diseases. Leading indica­tions include chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis and bronchiectasis, pulmonary arterial hypertension. Living donor lung transplantation (LDLT) was indicated for patients who experience a decline in physical condition and have limited life expectancy and had the better result than from brain dead. The first case of LDLT in Vietnam is 7 year olds boy with difuse congenital bronchiectasis, chronic respiratory failure and cor pulmonale. The right and left lower lobes from father and relative uncle are implanted in a recipient in place of whole right and left lung. The initial result of this recipient showed that lung function recuperated quickly and had no early complications. After 12 months surgery, the recipient had normal physical exercise capacity, subclinical tests in normal limits and no respiratory symptoms, opportunistic infection.
    Author Contributions
    Received Feb 11, 2018     Accepted Feb 21, 2018     Published Feb 26, 2018

    Copyright© 2018 Q Do, et al.
    License
    Creative Commons License   This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Funding Interests:

    Citation:

    Q Do, Viet T Tran, Manh A Hoang, Truong G Nguyen, Huy L Nguyen et al. (2018) The Initial Result Of The First Living Donor Lung Transplantation Case In Vietnam Journal of Advanced Therapeutic Science. - 1(1):1-5
    DOI

    Introduction

    Introduction

    Lung transplantation is an established treatment option for patients of end-stage lung diseases2610. The first lung transplantation case was performed by Hardy in the USA in 1963. Living donor lung transplantation (LDLT) was was introduced by Starnes and colleagues for patients who experience a decline in physical condition and have limited life expectancy141518. However, living donor single-lobe transplantation was not good results and developed bilateral LDLT, in which two healthy donors donate their right or lef lower lobes. It was the result for developing LDLT with both two sides341920. LDLT was suitable for children and small adults, and LDLT has been applied almost exclusively in patients with cystic fibrosis14. Now this technique is applicable in cases of restrictive, obstructive, infectious, and hypertensive lung disease in both pediatric and adult patients when the size matching is acceptable46816. The results of bilateral LDLT have been as good as or better than those of conventional cadaveric lung transplantation101316. In Vietnam, the first case of LDLT was performed on the 21st February 2017 in the Military Hospital 103 (University hospital of the Military Medical University). We report the initial result of this living donor lung transplantation case in Vietnam.

    Discussion

    Discussion

    In recent years, the number of lung transplantation patients has increased remarkbly with the trend to bilateral lung transplantation more than single lung transplantation. The sources of donors are extended, with non-heart beating donors, ex-vivo lung perfusion and living donors. LDLT is a last option chosen to save critically ill patient with end-stage pulmonary disease who cannot wait for organs from cadaveric donor4. In our receipient, the indication of lung transplantation was resonable because he always had recurent respiratory infection, decreased PaO2, increased oxygen requirements, hypercapnia, pulmonary arterial hypertension. Two donors were relative and young. The anatomic and functional size matchings between the receipient and two donors played a very important role in the success of this lung transplantation case. We use a formula to estimate graft FVC (Forced vital capacity) on the basis of the donor s measured FVC and the number of pulmonary segments being implanted4. The right lower lobe FVC of uncle estimated 0.71 (L), the left lower lobe FVC of father estimated 0.8 (L), the receipient FVC estimated 0.98 (L). Total FVC of the two grafs/ FVC of the recipient was 1.5 (according to the Japanese authors, it is acceptable when this ratio > 0.45). Therefore, after vetilation these 2 lung lobes expanded nearly completly with the size of the paient s chest cavity and by the 7th day, both 2 lung lobes had expanded completly. At the 1st, 3th, 6th , 9th and 12th month, the chest X-ray image are normal. The clinical change of the recipient: fever immediately after operation and recovered in 2 days, sputum in 5 days, oxygen therapy in 5 days; weaned off ventilator in 36 hours. After 4 days, he was withdrawn from thoracic drainage and could walk himself in the room at the 6th day after the operation. In the 1st, 3th, 6th, 9th and 12th month, he had normal physical activities, not any clinical symptoms (now he returns to school and takes part in all activities as his classmates), subclinical tests in normal limits and no evidence of opportunistic infection or rejection.

    The clinical and subclinical datas have shown that the receipient has recovered lung function very fast and no complications after transplantation. Previous studies have reported some complications in the recipient after lung transplantation, such as pulmonary edema, acute rejection, anatomous airways, chronic rejection and opportunistic infection, especially lung transplantation from brain dead donor4511. The best initial result in our receipient may relate to some factors: young and relative donors (≤ 30 years old); the anatomic and functional size matchings, as well as the HLA matchings between the receipient and two donors. Two donors had no complication in and after the operation. They recovered after 1 week and had normal lung function and return their normal life after 3 months. In previous studies, there was no mortality in live lobar donors and 15-20% donors suffered some kind of morbidity which is acceptable and similar to the standard lung resection8917.

    Affiliations:
    Affiliations: