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Case Reports
. 2025 May 22:9:100295.
doi: 10.1016/j.jhlto.2025.100295. eCollection 2025 Aug.

Resection of infarcted upper lobe with reimplantation of the lower lobe allograft after initial bilateral full-sized lung transplantation: a case report

An-Lies Provoost  1   2 , Paul De Leyn  1   2 , Hans G L Van Veer  1   2 , Lieven P Depypere  1   2 , Yanina Jansen  1   2 , Robin Vos  2   3 , Birgit Weynand  4 , Sophie Pirenne  4 , Dirk E Van Raemdonck  1   2 , Laurens J Ceulemans  1   2
Affiliations
Case Reports

Resection of infarcted upper lobe with reimplantation of the lower lobe allograft after initial bilateral full-sized lung transplantation: a case report

An-Lies Provoost et al. JHLT Open. .

Abstract

We describe the case of a patient with lobar-lung auto-reimplantation following bilateral lung transplantation because of vascular and bronchial anastomotic complications with upper lobe infarction. Pneumonectomy of the left allograft with ex-vivo upper lobectomy and lower lobe reimplantation was successfully performed, resulting in favorable short-term recovery and improving graft function at 7-month follow-up.

Keywords: Anastomotic complications; Lobar-lung auto-reimplantation; Lung transplantation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: DVR is Editor-in-Chief of JHLT Open and is supported by the Broere Charitable Foundation. RV is a senior Clinical Research Fellow of the Research Foundation-Flanders (FWO) (#1803521N). LJC is a senior Clinical Research Fellow of the Research Foundation-Flanders (FWO) (#18E2B24N) and is supported by a KU Leuven University Chair funded by Medtronic. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Chest X-ray 19 days post-transplant shows a vague shadowing in the left upper lobe.
Figure 2
Figure 2
Chest computed tomography scan 20 days postoperatively. A: Infarction of left upper lobe; B: Kinking of the left main pulmonary artery (arrow); C: Occlusion of the left superior pulmonary vein (star) and kinking of the left inferior pulmonary vein (arrow); D: Stenosis at the left bronchial anastomosis (arrow).
Figure 3
Figure 3
Chest ventilation/perfusion-scintigraphy 21 days postoperatively showing a left upper lobe mismatch with ventilation of the right lung 64% (14% upper, 12% middle, 38% lower lobe) versus left lung 36% (8% upper, 28% lower lobe), and perfusion of the right lung 73% (18% upper, 14% middle, 41% lower lobe) versus left lung 27% (2% upper, 25% lower lobe).
Figure 4
Figure 4
Macroscopic pictures after pneumonectomy and ex-situ upper lobe lobectomy. A: Anterior side of upper lobe post-lobectomy; B: Hilar side of upper lobe post-lobectomy; C: Antegrade flush with preservation solution of the lower lobe during the bench.
Figure 5
Figure 5
Histopathological findings consistent with infarction related to pulmonary artery thrombosis (A) and pulmonary vein thrombosis (B).
Figure 6
Figure 6
A: Chest computed tomography scan 162 days postoperatively; B: Chest X-ray 222 days postoperatively (superposition of bilateral breast implants).
See this image and copyright information in PMC

References

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