Parameters of donor-recipient size mismatch and survival after bilateral lung transplantation.
BACKGROUND
The purpose of this study was to investigate the relationship between donor-recipient height, gender and predicted estimates of total lung capacity (pTLC) mismatches and post-transplant survival.


METHODS
The lung transplant databases at three programs were reviewed. The pTLC ratios (donor pTLC/recipient pTLC) and height ratios (donor height/recipient height) were calculated retrospectively. Patients were grouped according to pTLC ratio ≤1.0 or >1.0 and height ratio ≤1.0 or >1.0, and according to gender (mis-)matching. A time-to-event analysis was performed for risk of death after transplantation conditional on 30-day survival using Kaplan-Meier survival and Cox proportional hazard models.


RESULTS
There were 211 adult bilateral lung transplant recipients who qualified for the analysis. Mean follow-up was comparable for all cohorts (range 2.21 to 3.85 years). In the univariate Cox proportional hazard models, a pTLC ratio >1.0 (HR 0.43, p = 0.002) and a height ratio >1.0 (HR 0.61, p = 0.03) were associated with better survival, and a female-donor-to-male-recipient gender mismatch (F-to-M) was associated with worse survival (HR 2.35, p = 0.01). In the multivariate Cox proportional hazard model accounting for F-to-M gender mismatch and height ratio >1.0, a pTLC ratio >1.0 remained associated with survival (HR 0.38, p = 0.015). However, accounting for a pTLC ratio >1.0, a height ratio of >1.0 and F-to-M mismatch were not associated with survival.


CONCLUSIONS
A pTLC ratio >1.0 is associated with improved survival after bilateral lung transplantation. The pTLC ratio might better reflect allograft-thorax mismatch than the height ratio, as it also accounts for effects of gender on lung and thoracic volumes.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. michael-eberlein@uiowa.edu
Michael
M
Eberlein
Robert M
RM
Reed
Solbert
S
Permutt
Mayy F
MF
Chahla
Servet
S
Bolukbas
Steven D
SD
Nathan
Aldo
A
Iacono
David B
DB
Pearse
Henry E
HE
Fessler
Ashish S
AS
Shah
Jonathan B
JB
Orens
Roy G
RG
Brower
D000328:Adult; D001827:Body Height; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000473:pathology*; D016040:Lung Transplantation / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D014019:Tissue Donors; D014109:Total Lung Capacity; D014180:Transplantation; D016896:Treatment Outcome