Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome

Michael Eberlein; Solbert Permutt; Mayy F Chahla; Servet Bolukbas; Steven D Nathan; Oksana A Shlobin; James H Shelhamer; Robert M Reed; David B Pearse; Jonathan B Orens; Roy G Brower

doi:10.1378/chest.11-0767

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Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome

Journal article

Open access

Peer reviewed

Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome

Michael Eberlein, Solbert Permutt, Mayy F Chahla, Servet Bolukbas, Steven D Nathan, Oksana A Shlobin, James H Shelhamer, Robert M Reed, David B Pearse, Jonathan B Orens, …

Chest, Vol.141(2), pp.451-460

02/2012

DOI: 10.1378/chest.11-0767

PMCID: PMC5991546

PMID: 21799025

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Abstract

Size mismatch between donor lungs and a recipient thorax could affect the major determinants of maximal expiratory airflow: airway resistance, propensity of airways to collapse, and lung elastic recoil. A retrospective review of 159 adults who received bilateral lung transplants was performed. The predicted total lung capacity (pTLC) for donors and recipients was calculated based on sex and height. Size matching was represented using the following formula: pTLC ratio = donor pTLC / recipient pTLC. Patients were grouped according to those with a pTLC ratio > 1.0 (oversized) or those with a pTLC ratio ≤ 1.0 (undersized). Allograft function was analyzed in relation to the pTLC ratio and to recipient and donor predicted function. The 96 patients in the oversized cohort had a mean pTLC ratio of 1.16 ± 0.13 vs 0.89 ± 0.09 in the 63 patients of the undersized group. At 1 to 6 months posttransplant, the patients in the oversized cohort had higher FEV(1)/FVC ratios (0.895 ± 0.13 vs 0.821 ± 0.13, P < .01) and lower time constant estimates of lung emptying (0.38 ± 0.2 vs 0.64 ± 0.4, P < .01) than patients in the undersized cohort. Although the FVCs expressed as % predicted for the recipient were not different between cohorts, the FVCs expressed as % predicted for the donor organ were lower in the oversized cohort compared with the undersized cohort (at 1-6 months, 52.4% ± 17.1% vs 65.3% ± 18.3%, P < .001). Kaplan-Meier estimates for the occurrence of bronchiolitis obliterans syndrome (BOS) showed that patients in the oversized cohort had a lower probability of BOS (P < .001). A pTLC ratio > 1.0, suggestive of an oversized allograft, is associated with higher expiratory airflow capacity and a less frequent occurrence of BOS.

Postoperative Complications - etiology

Bronchiolitis Obliterans - etiology

Humans

Proportional Hazards Models

Organ Size

Male

Lung Transplantation

Analysis of Variance

Least-Squares Analysis

Adult

Female

Retrospective Studies

Respiratory Function Tests

Lung - anatomy & histology

Details

Title: Subtitle: Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome
Creators: Michael Eberlein - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD. Electronic address: michael-eberlein@uiowa.edu
Solbert Permutt - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
Mayy F Chahla - Division of Hospital Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
Servet Bolukbas - Department of Thoracic Surgery, Horst-Schmidt-Klinik, Wiesbaden, Germany
Steven D Nathan - Advanced Lung Disease Program, Inova Fairfax Hospital, Falls Church, VA
Oksana A Shlobin - Advanced Lung Disease Program, Inova Fairfax Hospital, Falls Church, VA
James H Shelhamer - Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
Robert M Reed - Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Maryland, Baltimore, MD
David B Pearse - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
Jonathan B Orens - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
Roy G Brower - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
Resource Type: Journal article
Publication Details: Chest, Vol.141(2), pp.451-460
DOI: 10.1378/chest.11-0767
PMID: 21799025
PMCID: PMC5991546
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Language: English
Date published: 02/2012
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; General Internal Medicine; Internal Medicine
Record Identifier: 9984094544902771

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