A scale for decision making between whole lung transplantation or lobar transplantation

In lung transplantation, appropriate size matching is of crucial importance to achieve satisfactory outcomes. Tailoring of the lung has been repeatedly described as successful means of overcoming size disparities. The goal of this study was to define a parameter helping the surgeon in the decision whether a standard lung transplantation or a lobar transplantation should be anticipated.

We retrospectively analysed the ratio between donor total lung capacity (TLC) and recipient TLC in all lung-transplant procedures performed in our institution from 1 January 2008 to 30 November 2008. The utility of this ratio using predicted recipient TLC (D/pR index) and real recipient TLC (D/rR index) in discriminating between whole lung transplantation and lobar transplantation was studied with the receiver operating characteristic (ROC) analysis.

The median D/pR index in whole lung transplantations was 1.01 (range: 0.69-1.26) and 1.19 in lobar transplantation (range: 1.09-1.54). In the range between 1.12 and 1.14, sensitivity and specificity are both above 90%. The area under the ROC curve for D/pR index was 0.96. The median D/rR index in whole lung transplantations was 0.95 (range: 0.56-2.74) and 1.58 in lobar transplantation (range: 0.85-2.56). The area under the ROC curve was 0.73.

We conclude that the D/pR index is more useful than D/rR index in discriminating between whole lung transplantation and lobar transplantation. With an area under the ROC curve of 0.96, this seems to be a suitable indicator in deciding between whole lung transplantation and lobar transplantation.