Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri.
Transplant Proc. 2023 Mar;55(2):432-439. doi: 10.1016/j.transproceed.2023.02.016. Epub 2023 Mar 12.
Accumulated knowledge on the outcomes related to size mismatch in lung transplantation derives from predicted total lung capacity equations rather than individualized measurements of donors and recipients. The increasing availability of computed tomography (CT) makes it possible to measure the lung volumes of donors and recipients before transplantation. We hypothesize that CT-derived lung volumes predict a need for surgical graft reduction and primary graft dysfunction.
Donors from the local organ procurement organization and recipients from our hospital from 2012 to 2018 were included if their CT exams were available. The CT lung volumes and plethysmography total lung capacity were measured and compared with predicted total lung capacity using Bland Altman methods. We used logistic regression to predict the need for surgical graft reduction and ordinal logistic regression to stratify the risk for primary graft dysfunction.
A total of 315 transplant candidates with 575 CT scans and 379 donors with 379 CT scans were included. The CT lung volumes closely approximated plethysmography lung volumes and differed from the predicted total lung capacity in transplant candidates. In donors, CT lung volumes systematically underestimated predicted total lung capacity. Ninety-four donors and recipients were matched and transplanted locally. Larger donor and smaller recipient lung volumes estimated by CT predicted a need for surgical graft reduction and were associated with higher primary graft dysfunction grade.
The CT lung volumes predicted the need for surgical graft reduction and primary graft dysfunction grade. Adding CT-derived lung volumes to the donor-recipient matching process may improve recipients' outcomes.
有关肺移植中大小不匹配相关结果的知识积累来自于预测的总肺容量方程，而不是供体和受体的个体化测量。随着计算机断层扫描（CT）的广泛应用，现在可以在移植前测量供体和受体的肺体积。我们假设 CT 衍生的肺体积可以预测是否需要进行手术移植物缩小和原发性移植物功能障碍。
纳入了 2012 年至 2018 年期间来自当地器官获取组织和我院的供体，如果其 CT 检查可用，则纳入研究。测量 CT 肺体积和体积描记法总肺容量，并使用 Bland-Altman 方法与预测的总肺容量进行比较。我们使用逻辑回归预测手术移植物缩小的需要，并使用有序逻辑回归对原发性移植物功能障碍的风险进行分层。
共纳入了 315 名移植候选者（575 次 CT 扫描）和 379 名供体（379 次 CT 扫描）。CT 肺体积与体积描记法肺体积非常接近，与移植候选者的预测总肺容量不同。在供体中，CT 肺体积系统地低估了预测的总肺容量。94 名供体和受体在当地进行了匹配和移植。CT 估计的较大供体和较小受体肺体积预测了手术移植物缩小的需要，并与更高的原发性移植物功能障碍分级相关。
CT 肺体积预测了手术移植物缩小的需要和原发性移植物功能障碍的分级。将 CT 衍生的肺体积添加到供体-受体匹配过程中可能会改善受者的结局。
