生体肺移植後の慢性移植肺機能不全（CLAD）

Chronic Lung Allograft Dysfunction after Living-donor Lobar Lung Transplantation

1998年に当院で日本初の生体肺移植が施行されて以来1），2020年までに日本では838例の肺移植が施行された．このうち約30％にあたる251例が生体肺移植であり，2010年の改正臓器移植法施行後の脳死肺移植数の増加によりその割合は減少しているものの，小児肺移植や緊急肺移植では依然として重要な役割を果たしている．

Long-term survival after living-donor lobar lung transplantation （LDLLT） is hampered by the development of chronic lung allograft dysfunction （CLAD）, similar to the clinical courses seen in some recipients of cadaveric lung transplantation （CLT）. CLAD after bilateral LDLLT has been shown to be characterized by the development in the unilateral lung due to differences in the immunological features of the two donors. Based on this characteristic, we found that lung perfusion scintigraphy, which can show a perfusion shift to the contralateral unaffected lung with the development of CLAD, had the potential to predict unilateral CLAD after bilateral LDLLT. Moreover, we found that CLAD, especially restrictive allograft syndrome, developed significantly later after bilateral LDLLT than after bilateral CLT, although the CLAD-free survival and overall survival after bilateral LDLLT were similar to those after bilateral CLT. We describe our experience of CLAD after bilateral LDLLT since the first case of LDLLT in Japan.