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Chronic kidney disease (CKD) is a common late complication associated with increased mortality after lung transplantation. Given the increased risk of infection in dialysis patients, late living-donor kidney transplantation (LDKT) provides excellent long-term survival in patients on dialysis after lung transplantation. However, recipients of living-donor lobar lung transplantation (LDLLT) might have scarce opportunity to receive LDKT due to the limited availability of living donors (LDs) for the second transplantation. We describe a successful case of late LDKT from the same donor after LDLLT. A 23-year-old woman with lymphangioleiomyomatosis underwent bilateral LDLLT of the right lower lobe from her brother and left lower lobe from her mother. Twelve years after LDLLT, she required hemodialysis for severe CKD. At the age of 37, she underwent LDKT from her mother, who was also an LD for the LDLLT. The postoperative courses of both the recipient and donor were uneventful, and the recipient remains in good physical condition (at the time of writing) despite developing recurrent lymphangioleiomyomatosis 23 years after the LDLLT, that is, 9 years after the LDKT. Her mother, the dual-organ LD, was able to return to her previous lifestyle. Late LDKT even from the same donor might be a viable option for patients developing severe CKD after LDLLT.

A 34-year-old man with KMT2A-MLLT1 acute myeloid leukemia in first complete remission underwent allogeneic peripheral blood stem cell transplantation from his HLA-matched sister after conditioning with busulfan/cyclophosphamide. He did not have severe graft-versus-host disease, but he developed interstitial pneumonia six months after transplantation when his oral cyclosporine A (CsA) dose was reduced to 10 mg/day. He was given prednisolone (PSL), which temporarily improved his respiratory condition, but he quickly deteriorated when PSL was reduced. Anti-MDA5 antibody was found to be positive after additional testing, and a three-drug combination of intravenous cyclophosphamide+PSL+CsA was initiated for anti-MDA5 antibody positive rapidly progressive interstitial lung disease, which was effective for interstitial pneumonia. He received a successful living-donor lung transplant from his younger brother and sister. We present a case of rapidly progressive anti-MDA5 antibody positive interstitial lung disease in which the patient's respiratory condition improved after triple therapy and subsequent living-donor lung transplantation.

Objective: Living-lung donors lose pulmonary function of a right or left lower lobe in exchange for a noble donation; however, Chen and colleagues reported postoperative pulmonary function of the donors was significantly better than the estimated values. The purpose of this study was to investigate if the improvement of postoperative pulmonary function is associated with hypertrophic phenomena of remnant lung., Methods: A total of 35 patients who underwent a right or left lower lobectomy for living-donor lobar lung transplantation in Kyoto University Hospital from 2008 to 2011 were evaluated by means of spirometry (forced vital capacity, forced expiratory volume in 1 second, and diffusing capacity for carbon monoxide), and computed tomography scans both before and 1 year after the surgery. Postoperative predictions of pulmonary function and radiologic parameters were made based on the number of resected segments. The average radiologic density of the lung was determined as follows: (mean computed tomography number + 1000)/1000, and weight of the lung was calculated as follows: lung volume (mL) × average radiologic lung density (g/mL). The radiologic analysis was performed on both the surgical and contralateral sides., Results: Postoperative forced vital capacity, forced expiratory volume in 1 second, and diffusing capacity for carbon monoxide were significantly higher than estimated values by 17.3% ± 10.2% (P < .0001), 14.7% ± 10.2% (P < .0001), and 10.9% ± 16. % (P < .002), respectively. Postoperative lung volume and weight of the surgical side were significantly higher than estimated values by 54.4% ± 30.4% (P < .0001) and 28.1% ± 15.7% (P < .0001), respectively. On the contralateral side, the postoperative lung volume was significantly higher than the estimated value by 12.6% ± 15.3% (P < .0001), but postoperative weight was comparable with the estimated value (-2.3% ± 8.8%; P = .07)., Conclusions: Hypertrophic change of the ipsilateral remnant lung may be recognized in living lung donors., (Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)