A simplified strategy for donor-recipient size-matching in lung transplant for interstitial lung disease

https://doi.org/10.1016/j.healun.2021.06.013Get rights and content

Background

Donor-recipient size-matching has been repeatedly reported to improve outcomes following lung transplantation (LTx). However, there is significant variability in practice and the optimal strategy for size-matching is yet to be defined. For recipients with ILD, size-matching decisions are complicated by concerns regarding the potential impact of pre-LTx pulmonary restriction. We evaluate whether a specific donor-to-recipient size-matching strategy, based on predicted total lung capacity, benefits this patient group.

Methods

This retrospective, single-centre, cohort study describes the post-LTx outcomes of adults who underwent LTx for ILD between 1983 and 2020. Only patients with restrictive physiology, based on pre-LTx pulmonary function testing were included. Post-LTx outcomes were compared based on donor-recipient predicted TLC (D-R pTLC) ratio. A D-R pTLC ratio of ≥0.8 or <1.2 for DLTx, and a D-R pTLC ratio of ≥0.8 or <1.0 for SLTx were classified as ‘size-matched’.

Results

Five-hundred and fifty LTx recipients met inclusion criteria. Of these, 404 underwent DLTx and 146 underwent SLTx. Size-matching was achieved in 78% of DLTx and 47% of SLTx. Overall survival (p = 0.007) and CLAD-free survival (p < 0.001) was significantly improved following a size-matched DLTx, compared to those with D-R pTLC ratios <0.8 or ≥1.2. Size-matching based on a D-R pTLC ratio 0.8≥ <1.0 for SLTX did not significantly improve survival.

Conclusions

D-R pTLC size-matching, based on a ratio of 0.8≥ <1.2 improved post-DLTx outcomes for patients with restrictive lung disease. This is simple to do, and if applied clinically, could improve overall outcomes in lung transplantation.

Section snippets

Study design and patient selection

This retrospective, single-centre, cohort study describes the post-LTx outcomes of all adults who underwent transplantation for ILD between November 07, 1983 and February 20, 2020. ILD patients were included if pre-LTx pulmonary function testing showed evidence of a restrictive physiology, based on either an actual TLC <80% predicted or a FEV1/FVC ratio >0.85 with a FVC <80% predicted (in the absence of a TLC measurement).13 The severity of pre-LTx restriction was graded as mild-moderate (FVC

Results

Five hundred and fifty adult LTx recipients were included in this study. Of these, 404 underwent double lung transplantation (DLTx) and 146 underwent single lung transplantation (SLTx). Outcomes following SLTx or DLTx were compared separately, based on D-R pTLC ratio.

Discussion

In this study, we report the impact of using pTLC for donor-recipient size-matching on post-LTx outcomes of ILD patients with restrictive lung disease. We identify improved short- and long- term outcomes following DLTx when a D-R pTLC ratio of ≥0.8 and <1.2 was achieved. Beneficial peri-operative effects include reduced requirement for donor LVRS, lower rates of grade 3 PGD, and improved 30-day survival. Additionally, overall survival and CLAD-free survival was improved. We further report a

Author contributions

All authors meet the following criteria for authorship:

  • Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and

  • Drafting the work or revising it critically for important intellectual content; and

  • Final approval of the version submitted for publication; and

  • Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately

Disclosure statement

The authors have no conflict of interest to disclose.

Acknowledgments

The authors would like to thank Mr R. Ghany, Mr K. Qiu and Dr T. Martinu for their assistance with data retrieval.

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