Lung size mismatch and primary graft dysfunction after bilateral lung transplantation.

Abstract

BACKGROUND:

Donor-to-recipient lung size matching at lung transplantation (LTx) can be estimated by the predicted total lung capacity (pTLC) ratio (donor pTLC/recipient pTLC). We aimed to determine whether the pTLC ratio is associated with the risk of primary graft dysfunction (PGD) after bilateral LTx (BLT).

METHODS:

We calculated the pTLC ratio for 812 adult BLTs from the Lung Transplant Outcomes Group between March 2002 to December 2010. Patients were stratified by pTLC ratio >1.0 ("oversized") and pTLC ratio ≤1.0 ("undersized"). PGD was defined as any ISHLT Grade 3 PGD (PGD3) within 72 hours of reperfusion. We analyzed the association between risk factors and PGD using multivariable conditional logistic regression. As transplant diagnoses can influence the size-matching decisions and also modulate the risk for PGD, we performed pre-specified analyses by assessing the impact of lung size mismatch within diagnostic categories.

RESULTS:

In univariate analyses oversizing was associated with a 39% lower odds of PGD3 (OR 0.61, 95% CI, 0.45-0.85, p = 0.003). In a multivariate model accounting for center-effects and known PGD risks, oversizing remained independently associated with a decreased odds of PGD3 (OR 0.58, 95% CI 0.38 to 0.88, p = 0.01). The risk-adjusted point estimate was similar for the non-COPD diagnosis groups (OR 0.52, 95% CI 0.32 to 0.86, p = 0.01); however, there was no detected association within the COPD group (OR 0.72, 95% CI 0.29 to 1.78, p = 0.5).

CONCLUSION:

Oversized allografts are associated with a decreased risk of PGD3 after BLT; this effect appears most apparent in non-COPD patients.

• Authors: Michael Eberlein, Robert M Reed, Servet Bolukbas, Joshua M Diamond, Keith M Wille, Jonathan B Orens, Roy G Brower, Jason D Christie, Lung Transplant Outcomes Group
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 34 Issue 2 Pg. 233-40 (Feb 2015) ISSN: 1557-3117 [Electronic] United States
• PMID: 25447586 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Humans
• Lung (anatomy & histology)
• Lung Transplantation (adverse effects)
• Male
• Middle Aged
• Organ Size
• Primary Graft Dysfunction (diagnosis, epidemiology, physiopathology)
• Prospective Studies
• Risk Factors
• Survival Rate (trends)
• Tissue Donors
• Total Lung Capacity
• Transplantation, Homologous
• United States
• Young Adult