A simplified strategy for donor-recipient size-matching in lung transplant for interstitial lung disease
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:
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Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and
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Drafting the work or revising it critically for important intellectual content; and
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Final approval of the version submitted for publication; and
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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.
References (26)
- et al.
Predicted heart mass is the optimal metric for size match in heart transplantation
J Heart Lung Transplant
(2019) - et al.
Size mismatching increases mortality after lung transplantation in preadolescent patients
Ann Thorac Surg
(2019) - et al.
Lung size mismatch and primary graft dysfunction after bilateral lung transplantation
J Heart Lung Transplant
(2015) - et al.
Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome
Chest
(2012) - et al.
A review of lung transplant donor acceptability criteria
J Heart Lung Transplant
(2003) - et al.
Size matching in lung transplantation: an evidence-based review
J Heart Lung Transplant
(2013) - et al.
The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation
J Heart Lung Transplant
(2012) - et al.
The international thoracic organ transplant registry of the international society for heart and lung transplantation: twenty-second pediatric lung and heart-lung transplantation report-2019; focus theme: donor and recipient size match
J Heart Lung Transplant
(2019) - et al.
Global differences in lung function by region (PURE): an international, community-based prospective study
Lancet Respir Med
(2013) - et al.
Size mismatch in deceased donor liver transplantation and its impact on graft survival
Clin Transplant
(2019)
Donor-recipient weight and sex mismatch and the risk of graft loss in renal transplantation
Clin J Am Soc Nephrol
Chest X-ray sizing for lung transplants reflects pulmonary diagnosis and body composition and is associated with primary graft dysfunction risk
Transplantation
Predictive equations for lung volumes from computed tomography for size matching in pulmonary transplantation
J Thorac Cardiovasc Surg
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