Height is used in allocation of donor lungs as an indirect estimate of thoracic size. Total lung capacity (TLC), determined by both height and sex, could be a more accurate functional estimation of thoracic size. Size-matching criteria based on height versus predicted TLC was retrospectively evaluated, and, furthermore, whether a TLC mismatch was related to clinical and functional complications.The ratio of donor and recipient height, as well as the ratio of predicted TLC in donors and recipients, were calculated in 80 patients after bilateral lung transplantation. Complications evaluated included persistent atelectasis, persistent pneumothorax and increased number of days in intensive care, occurrence of bronchiolitis obliterans syndrome and limitation of exercise capacity.Median height donor/recipient ratio was 1.01 (0.93-1.12). Median predicted TLC donor/recipient ratio was 1.01 (with a clearly broader range 0.72-1.41). Neither sex mismatch nor TLC mismatch were related to clinical or functional complications.Allocation of donor lungs based upon height alone leads to a substantial mismatch in total lung capacity caused by sex mismatch. The absence of complications suggests that a greater height donor/recipient discrepancy can be accepted for allocation than previously assumed. Eur Respir J 2002; 20: 1419-1422. Size matching in lung transplantation (LT) has been performed in the past by measuring the submammary thoracic perimeter [1,2], by matching chest radiographs [3,4], anthropometry, weight [5], predicted lung size [6] and height. However, none of these methods guarantee an appropriate lung size with respect to the size of the thoracic cage. The best approach to donor/recipient (D/R) size matching has not been determined so far.In general, allocation of donor lungs is based primarily on blood group and height. Height mismatch may sometimes preclude allocation. The effect of the anatomical difference in shape of the thoracic cavity between males and females on the possible permitted height mismatch is unknown. Size matching based upon height alone may be associated with discrepancies in estimated thoracic size in case of a sex mismatch. A female recipient will receive a greater lung from a male donor although the height of donor and recipient is equal. Similarly, a male recipient will receive a smaller lung from a female donor although height of donor and recipient is equal. Total lung capacity (TLC) depends on height and sex and may thus be regarded as a more accurate, functional estimation of thoracic size.In the present study, size matching based on height versus size matching based on height and sex were retrospectively evaluated by calculating ratios of D/R height as well as ratios of predicted D/R TLC. Since an increased range of ratios of predicted TLC was expected, the authors investigated whether these size discrepancies led to clinical and/or functional complications.
Methods
PatientsNinety-six bilateral LT (BLT) were performed between November 1990 and September 1998 in the Groningen Un...
HLA-DR mismatching appears to be a risk factor for the development of BOS and graft loss. Improved outcome after lung transplantation might be achieved with prospective matching for HLA-DR. Alternatively, the amount and type of immunosuppressive drugs may be guided by the degree of HLA-DR (mis)matching.
In The Netherlands, when taking into account current refusal percentages, 320 to 360 organ donations and 5,800 tissue donations could be effectuated if organ donation is posed to all possible donors. For this, knowledge of medical criteria and contraindications for donation by the physicians and their willingness to discuss donation with next of kin must be improved.
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