Impact of flat chest on cadaveric lung transplantation: postoperative pulmonary function and survival

Thoracic cage flatness, the so-called flat chest, is a chest wall deformity associated with end-stage lung disease requiring lung transplantation. There is little information on the impact of flat chest on lung transplantation. The purpose of this study was to investigate whether flat chest directly influences respiratory function and survival after cadaveric lung transplantation.

Data from 68 patients who underwent cadaveric lung transplantation between August 2010 and September 2017, excluding patients with chronic obstructive pulmonary disease and lymphangioleiomyomatosis, were retrospectively collected and divided into 2 groups: a flat chest group (n = 30) and a non-flat chest group (n = 38). Flat chest was diagnosed when the ratio of the thoracic anteroposterior diameter to the transverse diameter was 1/3 or less. Preoperative characteristics, postoperative pulmonary function, exercise capacity and survival were compared between the 2 groups.

Preoperative forced vital capacity (FVC) and %FVC were significantly lower in the flat chest group. A downsizing of lobar transplantation to overcome size disparity was more frequent in the flat chest group (P = 0.04). However, there were no significant differences in the ratio of postoperative FVC to the preoperatively estimated FVC and postoperative 6-min walk distances between the 2 groups. The 5-year overall survival rate of patients in the flat chest group and the non-flat chest group was 64.3% and 66.5%, respectively (P = 0.87).

Although tailoring of the donor lung was occasionally needed for flat chest patients, postoperative function and survival of flat chest patients were satisfactory compared with those of non-flat chest patients after cadaveric lung transplantation.