Chest size matching in single and double lung transplantation

Abstract

We applied predicted vital capacity to chest size matching between donor and recipient in lung transplantation to 15 single-lung transplant recipients with pulmonary fibrosis and to 20 double-lung transplant recipients with emphysema or non-emphysema. The predicted vital capacity of the donor was significantly correlated with the predicted vital capacity of the recipient both in double-lung transplantation (r = 0.79, p = 0.001) and single-lung transplantation (r = 0.71, p = 0.003). In double-lung transplantation, the post-transplant vital capacity was correlated with the predicted vital capacity of the recipient (r = 0.74, p = 0.002). Emphysema patients and non-emphysema patients contributed equally to this correlation. In left single lung transplantation, there was a weak correlation between the post-transplant vital capacity and the predicted vital capacity of the donor in the allograft (r = 0.57, p = 0.1095). In right single lung transplantation, the post-transplant vital capacity of the allograft tended to be correlated with the predicted vital capacity of recipient (r = 0.77, p = 0.0735). We concluded that donors were actually selected based on the comparison of predicted vital capacity between donor and recipient. In double-lung transplantation, the post-transplant vital capacity was limited by the recipient's normal thoracic volume and was not influenced by underlying pulmonary disease. In single-lung transplantation with pulmonary fibrosis, the allograft transplanted in the left chest could expand to its own size, and the allograft transplanted in the right chest could expand to the recipient's normal thoracic volume as in double-lung transplantation.

Donor Total Lung Capacity Predicts Recipient Total Lung Capacity After Size-reduced Lung Transplantation

“…7 Our findings confirm this report, because, in standard lung transplantation, recipient size is a significant predictor of post-operative TLC as percent predicted; however, this correlation is not apparent in reduced-size lung transplants. Two reports, one dealing solely with single-lung transplantation 8 and another dealing with both single-and double-lung transplantations, 9 concluded that post-operative lung function is dependent on pre-operative recipient values and no donor-derived value can determine functional outcome. In contrast, a recent study dealing with living donor lung transplantation reported that post-operative forced vital capacity (FVC) is determined by the amount of donor lung tissue implanted and is not dependent on recipient factors.…”

Donor predicted post-operative forced expiratory volume in one second predicts recipients’ best forced expiratory volume in one second following size-reduced lung transplantation

“…To avoid functional impairment, the amount of resected lung tissue has to be taken into account when size-reduced lung transplantation is performed [16]. Different opinions exist in the published literature as to whether postoperative lung function can be determined by donor or recipient factors [5,[17][18][19]. It has been shown that postoperative recipient TLC in size-reduced lung transplantation could be predicted by donor TLC with an excellent correlation between TLC and FEV 1 [5].…”

Computed tomography measurement of lung volume in preoperative assessment for living donor lung transplantation: Volume calculation using 3D surface rendering in the determination of size compatibility

“…Significant discrepancies in between the volumes of the lobar graft and the respective hemithorax of the recipient can increase complications (4–6). Very large grafts can impair the function of the diaphragm as occurs in severe emphysema.…”

“…In LDLLT, the lower lobe removed from the living donor is used as a graft to replace the whole lung of the recipient. Great discrepancy between the volume of the implanted lobe and of the thoracic cage of the recipient can occur and must be avoided, as it increases the risk of complications (2–8).…”