Differences in chronic lung allograft dysfunction between deceased-donor lung transplantation and living-donor lobar lung transplantation.

Objective: This study explored the characteristics and prognostic impact of chronic lung allograft dysfunction (CLAD) after deceased-donor lung transplantation and living-donor lobar lung transplantation, wherein the lower lobes from two donors are usually transplanted into one recipient.

Methods: The clinical data of 123 deceased-donor and 67 living-donor lung transplantations performed in adult patients at our institution between June 2008 and September 2019 were retrospectively reviewed. The cumulative incidence of CLAD was evaluated on a per-recipient and per-donor graft basis using the Kaplan-Meier method.

Results: The smaller number of human leukocyte antigen mismatches, shorter ischemic time, and lower incidence of grade 3 primary graft dysfunction were observed in living-donor transplantation than in deceased-donor transplantation (p<0.001). Restrictive allograft syndrome (RAS)-type CLAD occurred in 9 (20.9%) of 43 CLAD patients after deceased-donor transplantation and 9 (45.0%) of 20 CLAD patients after living-donor transplantation. CLAD occurred unilaterally in 15 patients (75.0%) after bilateral living-donor transplantation. Despite the higher incidence of RAS-type CLAD after living-donor transplantation, the overall survival rates after the transplantation and survival rates after the onset of CLAD were comparable between the deceased-donor transplant and living-donor transplant patients. The cumulative incidence of CLAD per recipient was similar between the deceased-donor and the living-donor transplant recipients (p=0.32). In the per-donor graft analysis, the cumulative incidence of CLAD was significantly lower in the living-donor grafts than in the deceased-donor grafts (p=0.003).

Conclusions: The manifestation of CLAD after living-donor lobar lung transplantation is unique and differs from that after deceased-donor lung transplantation.