Oversizing lung allografts deteriorates outcomes in patients with pulmonary fibrosis

Maximilian Franz ¹, Saleh Tavil ¹, Nunzio Davide de Manna ¹

⁰Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation +

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March 4, 2024

View abstract on PubMed

Summary

Oversizing lung allografts by more than 10% negatively impacts lung transplant outcomes. Undersized grafts showed better early and long-term survival for pulmonary fibrosis patients.

Area Of Science

Thoracic Surgery
Transplantation Medicine
Pulmonary Medicine

Background

Lung transplantation is the sole curative option for end-stage pulmonary fibrosis.
Optimal lung allograft sizing remains a critical, debated factor influencing postoperative results.
This study investigates the impact of donor-recipient predicted total lung capacity ratio (DRPR) on outcomes.

Purpose Of The Study

To determine the effect of lung allograft size mismatch on postoperative outcomes.
To compare outcomes between undersized, size-matched, and oversized lung allografts in pulmonary fibrosis patients.

Main Methods

Retrospective review of 422 lung transplant recipients from January 2010 to May 2023.
Patients categorized into undersized (DRPR <1.0), size-matched (1.0 ≤ DRPR <1.1), and oversized (DRPR ≥1.1) groups.
Outcomes analyzed using statistical methods including Kaplan-Meier and multivariable analyses.

Main Results

Oversized allografts (n=26) were associated with higher rates of PGD grade 3 and in-hospital mortality compared to undersized grafts (n=296).
Long-term survival was significantly better in the undersized group compared to both oversized and size-matched (n=101) groups.
A donor-recipient predicted total lung capacity ratio (DRPR) >1.1 indicated adverse outcomes.

Conclusions

Oversizing lung allografts by over 10% (DRPR ≥1.1) is linked to poorer early postoperative outcomes and reduced long-term survival.
Undersizing lung allografts may offer superior survival benefits for pulmonary fibrosis patients.
Careful consideration of allograft size is crucial for optimizing lung transplant success.

Keywords:

lung transplantation postoperative outcome pulmonary fibrosis single-center analysis size-matching