Mason David P, Batizy Lillian H, Wu Jeffrey, Nowicki Edward R, Murthy Sudish C, McNeill Ann M, Budev Marie M, Mehta Atul C, Pettersson Gösta B, Blackstone Eugene H
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Thorac Cardiovasc Surg. 2009 May;137(5):1234-40.e1. doi: 10.1016/j.jtcvs.2008.10.024.
The impact of size matching between donor and recipient is unclear in lung transplantation. Therefore, we determined the relation of donor lung size to 1) posttransplant survival and 2) pulmonary function as measured by forced expiratory volume in 1 second.
From 1990 to 2006, 469 adults underwent lung transplantation with lungs from donors aged 7 to 70 years. Donor and recipient total lung capacities were calculated using established formulae (predicted total lung capacity), and actual recipient lung size was measured in the pulmonary function laboratory. Disparity between donor and recipient lung size was expressed as a ratio of donor predicted total lung capacity to recipient predicted total lung capacity-the predicted total lung capacity ratio-and predicted donor total lung capacity to actual recipient total lung capacity-the actual total lung capacity ratio. Survival was measured by multiphase hazard methodology and repeated measures of National Health and Nutrition Examination Survey-normalized forced expiratory volume in 1 second analyzed by temporal decomposition.
Predicted total lung capacity ratio and actual total lung capacity ratio ranged widely, from 0.55 to 1.59 and 0.52 to 4.20, respectively. Overall survival was unaffected by predicted total lung capacity ratio (P = .3) or actual total lung capacity ratio (P = .5). Patients with emphysema and an actual total lung capacity ratio of 0.67 or less or 1.03 or greater had higher predicted mortality (P = .01). During the first posttransplant year, forced expiratory volume in 1 second increased and then gradually declined. Predicted total lung capacity ratio and actual total lung capacity ratio had a small impact on forced expiratory volume in 1 second, primarily in the late phase after transplant in a disease-specific manner.
Size matching between donor and recipient using predicted total lung capacity ratio and actual total lung capacity ratio is an effective technique. Wide discrepancies in lung sizing do not affect overall posttransplant survival or pulmonary function. Therefore, a greater degree of lung size mismatch can likely be accepted, thereby improving patients' odds of undergoing transplantation.
在肺移植中，供体与受体之间大小匹配的影响尚不清楚。因此，我们确定了供体肺大小与以下两方面的关系：1）移植后生存率；2）通过第1秒用力呼气量测量的肺功能。
1990年至2006年，469名成年人接受了来自7至70岁供体的肺移植。使用既定公式（预测总肺容量）计算供体和受体的总肺容量，并在肺功能实验室测量受体的实际肺大小。供体与受体肺大小的差异表示为供体预测总肺容量与受体预测总肺容量之比（预测总肺容量比）以及供体预测总肺容量与受体实际总肺容量之比（实际总肺容量比）。通过多阶段风险方法测量生存率，并通过时间分解对重复测量的美国国家健康和营养检查调查标准化第1秒用力呼气量进行分析。
预测总肺容量比和实际总肺容量比范围广泛，分别为0.55至1.59和0.52至4.20。总体生存率不受预测总肺容量比（P = 0.3）或实际总肺容量比（P = 0.5）的影响。患有肺气肿且实际总肺容量比为0.67或更低或1.03或更高的患者预测死亡率更高（P = 0.01）。在移植后的第一年，第1秒用力呼气量先增加然后逐渐下降。预测总肺容量比和实际总肺容量比对第1秒用力呼气量有较小影响，主要在移植后的后期以疾病特异性方式出现。
使用预测总肺容量比和实际总肺容量比进行供体与受体之间的大小匹配是一种有效的技术。肺大小的广泛差异不会影响移植后的总体生存率或肺功能。因此，可能可以接受更大程度的肺大小不匹配，从而提高患者接受移植的几率。
