Volume Reduction Techniques of the Graft and Reduced Size Transplantation

Lung transplantation is considered a therapeutic option in selected patients affected by end-stage lung disease. The shortage of donors available for transplantation and the subsequent mortality on the waiting list are the biggest concerns of the lung transplant community. There are various strategies to overcome this shortage; one of this is the use of lobar lung transplantation and other size reduction techniques (split lung transplantation, where left lung is divided and each lobe is implanted in the two hemi-thoraces and peripheral atypical resectionsPeripheral atypical resections). These surgical options are so far underutilized as they are only performed in highly specialized centers and frequently performed only in high urgency cases. Lobectomy for size reduction can be performed on the back table or after the implantation. All the combinations of lobes can be potentially resected. The size matching decision for lobar lung transplantation and other size reduction techniques is complex and depends on different parameters (height, total lung capacity, visual inspection in the operating room). Volume reduction techniques can be considered a valid tool to overcome donor shortage, particularly in urgent patients, with good outcomes, comparable to standard lung transplantation.