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Applied physiological principles in the management of a lung allograft to thoracic cavity size mismatch in severe emphysema
Journal article   Open access   Peer reviewed

Applied physiological principles in the management of a lung allograft to thoracic cavity size mismatch in severe emphysema

Michael Eberlein, John C. Keech and Robert M. Reed
JHLT Open, Vol.6, 100124
07/2024
DOI: 10.1016/j.jhlto.2024.100124
PMCID: PMC11935444
PMID: 40145029
url
https://doi.org/10.1016/j.jhlto.2024.100124View
Published (Version of record) Open Access

Abstract

In this review we discuss physiological principles that guided the management of a lung transplant for emphysema related to alpha-1-antitrypsin deficiency, where a lung allograft to thoracic cavity size mismatch occurred (donor to recipient predicted total lung capacity [pTLC] ratio was 0.89, donor pTLC to recipient actual-TLC ratio 0.62). In emphysema, the loss of lung elastic recoil and airways obstruction leads to air trapping and lung hyperinflation. Remodeling of the thoracic cavity (“barrel-chest”) develops, which has implications for donor-to-recipient sizing and post-operative management of lung transplantation. We discuss the physiology of a relatively undersized allograft and the impact on chest tube, mechanical ventilation, and respiratory system mechanics management. This case also illustrates how chronic adaptations of the ventilatory pattern to advanced lung diseases are reversible and the chest cavity size can remodel back to normal after lung transplantation.
 Collateral Ventilation Emphysema Lung Transplant Size Mismatch

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