Impact of graft volume reduction for oversized grafts after lung transplantation on outcome in recipients with end-stage restrictive pulmonary diseases.
BACKGROUND
Optimal size matching is critical to avoid problems from oversized grafts used in lung transplantation for restrictive pulmonary diseases in patients with a small chest cavity. Although graft volume reduction (GVR) is useful to overcome related disparities, its merits and demerits remain unclear.


METHODS
We performed 342 lung transplants during the period of January 2003 to April 2007. Of the lung transplant recipients, 167 recipients had end-stage restrictive pulmonary diseases, with 25 (15%) receiving grafts considered to be oversized because of height disparity. The present retrospective analysis was conducted to compare between patients with size-matched and oversized grafts, and patients who did (GVR group, n = 9) and did not (non-GVR group, n = 16) undergo GVR for an oversized graft.


RESULTS
Pulmonary functional improvement after 6 months was better in size-matched patients in view of percent forced vital capacity (FVC%) increase (29.8% vs 21.2%, p < 0.05), whereas long-term survival was not significantly different between the size-matched and oversized groups. Compared with the GVR group, the non-GVR group had a significantly higher incidence of short-term complications leading to respiratory failure (50% vs 11.1%, p < 0.05), whereas functional improvement was significantly worse in the non-GVR group (FVC% increase: 32.8% vs 19.9%, p < 0.05). However, overall patient survival at 3 years was not significantly different (non-GVR: 67%; GVR: 75%).


CONCLUSIONS
An oversized graft may lead to a higher incidence of short-term clinical complications with reduced pulmonary function improvement post-operatively in lung transplantation recipients with end-stage restrictive pulmonary diseases. The decision of whether to carry-out GVR at the time of transplantation with an oversized graft to improve outcome is of critical importance.
Shigemura
Norihisa
N
Division of Cardiopulmonary Transplantation, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. shigemura@thoracic.med.osaka-u.ac.jp
Bermudez
Christian
C
Hattler
Brack G
BG
Johnson
Bruce
B
Crespo
Maria
M
Pilewski
Joseph
J
Toyoda
Yoshiya
Y
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001827:Body Height; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000033:anatomy & histology*; D008171:Lung Diseases / Q000453:epidemiology*; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012727:Sex Characteristics; D014019:Tissue Donors / Q000706:statistics & numerical data; D014797:Vital Capacity