A simplified strategy for donor-recipient size-matching in lung transplant for interstitial lung disease.
donor-recipient size matching
interstitial lung disease
lung transplantation
predicted total lung capacity
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
ISSN: 1557-3117
Titre abrégé: J Heart Lung Transplant
Pays: United States
ID NLM: 9102703
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
08
12
2020
revised:
16
06
2021
accepted:
22
06
2021
pubmed:
25
7
2021
medline:
4
3
2022
entrez:
24
7
2021
Statut:
ppublish
Résumé
Donor-recipient size-matching has been repeatedly reported to improve outcomes following lung transplantation (LTx). However, there is significant variability in practice and the optimal strategy for size-matching is yet to be defined. For recipients with ILD, size-matching decisions are complicated by concerns regarding the potential impact of pre-LTx pulmonary restriction. We evaluate whether a specific donor-to-recipient size-matching strategy, based on predicted total lung capacity, benefits this patient group. This retrospective, single-centre, cohort study describes the post-LTx outcomes of adults who underwent LTx for ILD between 1983 and 2020. Only patients with restrictive physiology, based on pre-LTx pulmonary function testing were included. Post-LTx outcomes were compared based on donor-recipient predicted TLC (D-R pTLC) ratio. A D-R pTLC ratio of ≥0.8 or <1.2 for DLTx, and a D-R pTLC ratio of ≥0.8 or <1.0 for SLTx were classified as 'size-matched'. Five-hundred and fifty LTx recipients met inclusion criteria. Of these, 404 underwent DLTx and 146 underwent SLTx. Size-matching was achieved in 78% of DLTx and 47% of SLTx. Overall survival (p = 0.007) and CLAD-free survival (p < 0.001) was significantly improved following a size-matched DLTx, compared to those with D-R pTLC ratios <0.8 or ≥1.2. Size-matching based on a D-R pTLC ratio 0.8≥ <1.0 for SLTX did not significantly improve survival. D-R pTLC size-matching, based on a ratio of 0.8≥ <1.2 improved post-DLTx outcomes for patients with restrictive lung disease. This is simple to do, and if applied clinically, could improve overall outcomes in lung transplantation.
Sections du résumé
BACKGROUND
Donor-recipient size-matching has been repeatedly reported to improve outcomes following lung transplantation (LTx). However, there is significant variability in practice and the optimal strategy for size-matching is yet to be defined. For recipients with ILD, size-matching decisions are complicated by concerns regarding the potential impact of pre-LTx pulmonary restriction. We evaluate whether a specific donor-to-recipient size-matching strategy, based on predicted total lung capacity, benefits this patient group.
METHODS
This retrospective, single-centre, cohort study describes the post-LTx outcomes of adults who underwent LTx for ILD between 1983 and 2020. Only patients with restrictive physiology, based on pre-LTx pulmonary function testing were included. Post-LTx outcomes were compared based on donor-recipient predicted TLC (D-R pTLC) ratio. A D-R pTLC ratio of ≥0.8 or <1.2 for DLTx, and a D-R pTLC ratio of ≥0.8 or <1.0 for SLTx were classified as 'size-matched'.
RESULTS
Five-hundred and fifty LTx recipients met inclusion criteria. Of these, 404 underwent DLTx and 146 underwent SLTx. Size-matching was achieved in 78% of DLTx and 47% of SLTx. Overall survival (p = 0.007) and CLAD-free survival (p < 0.001) was significantly improved following a size-matched DLTx, compared to those with D-R pTLC ratios <0.8 or ≥1.2. Size-matching based on a D-R pTLC ratio 0.8≥ <1.0 for SLTX did not significantly improve survival.
CONCLUSIONS
D-R pTLC size-matching, based on a ratio of 0.8≥ <1.2 improved post-DLTx outcomes for patients with restrictive lung disease. This is simple to do, and if applied clinically, could improve overall outcomes in lung transplantation.
Identifiants
pubmed: 34301464
pii: S1053-2498(21)02388-3
doi: 10.1016/j.healun.2021.06.013
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1422-1430Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.