The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation.
BACKGROUND
Oversizing the lung allograft, as estimated by a donor-to-recipient predicted total lung capacity (pTLC) ratio > 1.0, was associated with improved long-term survival after lung transplantation (LTx) but could be associated with increased post-operative complications and higher resource utilization.


METHODS
The prospectively maintained LTx database at The Johns Hopkins Hospital was retrospectively reviewed for bilateral LTx patients in the post-Lung Allocation Score (LAS) era. Patients were grouped by pTLC ratio ≤ 1.0 (undersized) or > 1.0 (oversized). Post-operative complications and hospital charges were analyzed.


RESULTS
The pTLC ratio was available for 70 patients: 31 were undersized and 39 oversized. Undersized patients had a higher LAS (40.4 vs 35.8, p = 0.009), were more often in the intensive care unit (ICU) pre-LTx (35% vs 10%, p = 0.01), and had a higher occurrence of primary graft dysfunction (PGD; 25% vs 5%, p = 0.013) and tracheostomy (32% vs 10%, p = 0.02), longer index hospitalizations (20 [interquartile range (IQR), 10-46] vs 16 [IQR, 12-25] days, p = 0.048), and higher index hospitalization charges ($176,247 [IQR, $137,646-$284,012] vs $158,492 [IQR, $136,250-$191,301], p = 0.04). After adjusting for LAS and pre-LTx ICU stay, a lower pTLC ratio remained associated with higher hospital charges (p = 0.049). Airway complications were more frequent and severe in undersized patients.


CONCLUSIONS
Oversized allografts were not associated with an increase in post-LTx complications. However, LTx recipients of undersized allografts were more likely to experience PGD, tracheostomy, and had higher resource utilization. Higher acuity in the undersized group might explain these findings; however, multivariate models suggest an independent association between undersizing, PGD, and resource utilization.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. michael-eberlein@uiowa.edu
Michael
M
Eberlein
George J
GJ
Arnaoutakis
Lonny
L
Yarmus
David
D
Feller-Kopman
Rebecca
R
Dezube
Mayy F
MF
Chahla
Servet
S
Bolukbas
Robert M
RM
Reed
Julia
J
Klesney-Tait
Kalpaj R
KR
Parekh
Christian A
CA
Merlo
Ashish S
AS
Shah
Jonathan B
JB
Orens
Roy G
RG
Brower
D000328:Adult; D015142:Baltimore; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000473:pathology*; D016040:Lung Transplantation / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous