Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore.
Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore.
Ann Thorac Surg. 2019 Jul;108(1):130-137. doi: 10.1016/j.athoracsur.2019.01.015. Epub 2019 Feb 11.
The effect of size mismatch between donor and recipient in pediatric lung transplantation (PLTx) is currently unknown. Previous studies in adults have suggested that oversized allografts are associated with improved outcomes after lung transplantation. We investigated this relationship to quantify its effect on posttransplant outcomes in children.
The United Network of Organ Sharing database was queried for preadolescent (age <13 years) patients undergoing PLTx. Donor-to-recipient height, weight, and predictive total lung capacity (pTLC; ages 4 to 13; pTLC = 0.160 x exp[0.021 x height]) ratios were calculated. Exploratory analysis was performed to identify disjoint intervals at which survival was statistically different. Patients were categorized as well-matched, undersized, or oversized. Multivariate Cox proportional hazard regression modeling assessed the adjusted effect of mismatching on mortality. Survival analysis was performed using the Kaplan-Meier method.
The analysis included 540 children. One-year mortality was higher with a height mismatch of 5% or less (hazard ratio [HR], 2.97; p = 0.001) and above 5% (HR, 2.22; p = 0.009). Similarly, 1-year mortality was worse with weight mismatch of 10% or less (HR, 1.99; p = 0.035) and above 10% (HR, 2.04; p = 0.028). On unadjusted analysis, a pTLC ratio of less than 0.9 was associated with worse survival (p = 0.017). This finding persisted after multivariate risk adjustment (HR, 2.93; p = 0.02). Contrary to findings in adults, an oversized allograft (pTLC ratio > 1.1) was not associated with improved survival (HR, 1.95; p = 0.147).
In preadolescent children undergoing PLTx, size mismatching is associated with increased death. Our findings differ from studies in adults, which demonstrated improved survival associated with oversized allografts. Accordingly, well-matched allografts should be prioritized when assessing donor-recipient pairs for transplantation.
供体和受体之间大小不匹配对儿科肺移植（PLTx）的影响目前尚不清楚。之前在成人中的研究表明，供体肺过度增大与肺移植后改善的结果相关。我们研究了这种关系，以量化其对儿童移植后结果的影响。
查询了 United Network of Organ Sharing 数据库中接受 PLTx 的未成年（年龄 <13 岁）患者。计算供体与受体的身高、体重和预测总肺容量（pTLC；年龄 4 至 13 岁；pTLC=0.160 x exp[0.021 x 身高]）比。进行了探索性分析，以确定生存统计学上不同的不连续间隔。将患者归类为匹配良好、小于正常或大于正常。多变量 Cox 比例风险回归模型评估了不匹配对死亡率的调整影响。使用 Kaplan-Meier 方法进行生存分析。
分析包括 540 名儿童。身高匹配差 5%或更小（危险比 [HR]，2.97；p=0.001）和大于 5%（HR，2.22；p=0.009）的患者一年死亡率更高。同样，体重不匹配差 10%或更小（HR，1.99；p=0.035）和大于 10%（HR，2.04；p=0.028）的患者一年死亡率更差。在未调整的分析中，pTLC 比值小于 0.9 与生存率更差相关（p=0.017）。在多变量风险调整后，这一发现仍然存在（HR，2.93；p=0.02）。与成人研究结果相反，供体肺过度增大（pTLC 比值>1.1）并不与改善的生存率相关（HR，1.95；p=0.147）。
在接受 PLTx 的未成年儿童中，大小不匹配与死亡率增加相关。我们的研究结果与成人研究不同，后者表明供体肺过度增大与生存率提高相关。因此，在评估供体-受体对移植的匹配时，应优先考虑匹配良好的供体肺。
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