Open AccessTransplant size mismatch in restrictive lung disease
Author(s) -
Ganapathi Asvin M.,
Mulvihill Michael S.,
Englum Brian R.,
Speicher Paul J.,
Gulack Brian C.,
Osho Asishana A.,
Yerokun Babatunde A.,
Snyder Laurie R.,
Davis Duane,
Hartwig Matthew G.
Publication year - 2017
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12913
Subject(s) - medicine , lung , proportional hazards model , continuous variable , lung transplantation , hazard ratio , surgery , urology , confidence interval
Summary To maximize the benefit of lung transplantation, the effect of size mismatch on survival in lung transplant recipients with restrictive lung disease ( RLD ) was examined. All single and bilateral RLD lung transplants from 1987 to 2011 in the United Network for Organ Sharing ( UNOS ) Database were identified. Donor predicted total lung capacity ( pTLC ):Recipient pTLC ratio ( pTLC r) quantified mismatch. pTLC r was segregated into five strata. A Cox proportional hazards model evaluated the association of pTLC r with mortality hazard. To identify a critical pTLC r, a Cox model using a restricted cubic spline for pTLC r was used. A total of 6656 transplants for RLD were identified. Median pTLC r for single orthotopic lung transplant ( SOLT ) and bilateral orthotopic lung transplant ( BOLT ) was 1.0 (0.69–1.47) and 0.98 (0.66–1.45). Examination of pTLC r as a categorical variable revealed that undersizing ( pTLC r <0.8) for SOLT and moderate oversizing ( pTLC r = 1.1–1.2) for SOLT and BOLT had a harmful survival effect [for SOLT pTLC <0.8: HR 1.711 (95% CI 1.146–2.557), P = 0.01 and for BOLT pTLC 1.1–1.2: HR 1.717 (95% CI 1.112–2.651), P = 0.02]. Spline analysis revealed significant changes in SOLT mortality by variation of pTLC r between 0.8–0.9 and 1.1–1.2. RLD patients undergoing SOLT are susceptible to detriments of an undersized lung. RLD patients undergoing BOLT have higher risk of mortality when pTLC r falls between 1.1 and 1.2.