Sizing in lung transplantation: principles, practices and ideas for the future

Area of Science:

• Pulmonary Medicine
• Transplant Surgery
• Physiology

Background:

• Lung transplantation (LTx) offers improved quality of life and longevity for end-stage lung disease patients.
• Optimizing donor-to-recipient size matching is key to increasing transplant success and patient outcomes.

Purpose of the Study:

• To provide a framework for optimizing donor-to-recipient size matching in LTx using physiological principles.
• To discuss the role of predicted total lung capacity (pTLC) and other metrics in LTx recipient management.

Main Methods:

• Review of pulmonary gas exchange and respiratory system mechanics principles.
• Utilizing predicted total lung capacity (pTLC) derived from regression equations (height, sex, age) as a primary size estimate.
• Consideration of chest cavity "reverse remodeling" and additional imaging-based metrics (CT, X-ray) when necessary.

Main Results:

• The donor-to-recipient pTLC ratio is a pragmatic metric for lung size matching.
• Significant undersizing based on pTLC ratio correlates with increased complications and reduced LTx survival.
• Imaging-based volumetric analyses can supplement pTLC for complex cases.

Conclusions:

• Accurate donor-to-recipient size matching, particularly using pTLC ratio, is vital for optimizing LTx outcomes.
• Addressing chest cavity changes and employing supplementary imaging metrics enhances transplant success.
• Effective size matching strategies contribute to improved long-term survival for lung transplant recipients.