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).

Gender differences in long‐term survival post‐transplant: A single‐institution analysis in the lung allocation score era

“…Female donors tend to be smaller in size than male donors; this size discrepancy can contribute to PGD. 10,11,19 Conversely, female recipients can do well no matter what size graft they receive; their slightly lower metabolic demand accommodates smaller grafts, and larger grafts can reduce PGD. 11 There may also be a selection bias for females who survive to transplant.…”

“…10,11,19 Conversely, female recipients can do well no matter what size graft they receive; their slightly lower metabolic demand accommodates smaller grafts, and larger grafts can reduce PGD. 11 There may also be a selection bias for females who survive to transplant. Sell and colleagues demonstrated that patients (often females) with shorter stature have a 62% higher death or removal rate on the waitlist due to clinical deterioration.…”

“…Thus, for improving outcomes and preventing PGD, appropriate donor-recipient size matching might be more relevant than donor-recipient gender matching per se. 10,11 The initiation of the lung allocation score (LAS) in the United States-by the United Network for Organ Sharing through the Organ Procurement and Transplantation Network-has changed the dynamics of the field, giving priority to higher-risk transplant candidates.…”

Early postoperative complications after lung transplantation

“…Характер влияния данного несоответствия на вероятность развития осложнений, в частности ПДЛТ, зависит от основного заболевания и того, как оно изменяет объем плевральных полостей и механику дыхания [65].…”

Measure twice, cut once: Increasing the precision of size matching in lung transplantation

“…Indeed, there are some data that would suggest that oversized allografts are associated with a decreased risk of higher-grade primary graft dysfunction. 6 One explanation for this finding is that an oversized allograft may receive a more protective ventilatory strategy (inherent to the smaller tidal volume ratio) and operate at lower pulmonary vascular resistance relative to the amount of blood flow for that lung. Although some progress is being made, we have surprisingly limited published data on this topic to guide surgeons in the decision-making for size matching of donors and recipients.…”