Effect of Donor Lung Resection Technique on Bronchopleural Fistula in Transplantation: Pulmonary Tailoring Versus Hilar Dissection

Abstract

Purpose: Donor shortages in many countries necessitate the use of marginal donor lungs despite challenges such as size mismatch, and donor lung pathologies requiring resection, such as consolidation or anatomical abnormalities. One way to address these challenges is through major pulmonary resection of the donor lung, which can be in the form of hilar dissection (HD), an anatomical resection, or pulmonary tailoring (PT), a non-anatomical resection. No studies have compared these two techniques; hence, we aimed to compare their intraoperative and postoperative outcomes. Materials and Methods: We retrospectively analyzed 40 lung transplant recipients who underwent major pulmonary resection of donor lungs between January 2014 and May 2023. The patients were divided into HD (n=18) and PT (n=22) groups, and their intraoperative and postoperative outcomes were compared. Results: Postoperative bronchopleural fistula (BPF) occurred in 22.2% of patients in the HD group but was absent in the PT group (p=0.033). There were no significant differences between the two groups in terms of total operative time, ischemic time for each lung, occurrence of primary graft dysfunction, bronchial anastomotic dehiscence, bronchial stenosis, or pneumothorax. The survival curves were also similar between the two groups. Conclusion: The PT technique significantly reduced the risk of BPF compared with the HD technique, suggesting its potential as a safer technique for managing oversized donor lungs and addressing other pathologies requiring resection.