Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
J Heart Lung Transplant. 2024 Jul;43(7):1126-1134. doi: 10.1016/j.healun.2024.02.1460. Epub 2024 Mar 2.
Lung transplantation is the only curative treatment for patients with end-stage pulmonary fibrosis. It is still under debate whether over- or undersizing of lung allografts is preferably performed regarding the postoperative outcome. We therefore analyzed our data using predicted total lung capacity to compare size mismatches.
Patient records were retrospectively reviewed. Three groups were formed, 1 including patients with a donor-recipients pTLC ratio (DRPR) of <1.0 (undersized group), the second with a DRPR of ≥1.0 and <1.1 (size-matched group), and the third group with a DRPR of ≥1.1 (oversized group). Outcomes were evaluated using chi-square test and Kruskall-Wallis test as well as Kaplan-Meier analysis, competing risk analysis, and multivariable analysis, respectively.
Between January 2010 and May 2023, among the 1501 patients transplanted at our institution, 422 (28%) patients were included, 26 (2%) patients forming the oversized group (median DRPR: 1.14), 101 (7%) patients forming the size-matched group (median DRPR: 1.03), and 296 (20%) patients forming the undersized group (median DRPR: 0.92). Patients from the oversized group had a higher PGD grade 3 rate at 24 (p < 0.001), 48 (p < 0.001), and 72 (p = 0.039) hours after transplantation as well as a higher in-hospital mortality compared to the undersized group (p = 0.033). The long-term survival was also better in the undersized group compared to the oversized group (p = 0.011) and to the size-matched group (p = 0.01).
Oversizing lung allografts more than 10% deteriorated early postoperative outcomes and long-term survival in patients with pulmonary fibrosis.
肺移植是治疗终末期肺纤维化患者的唯一根治性治疗方法。关于术后结果，是选择肺移植供体大小过大还是过小，目前仍存在争议。因此，我们使用预测的总肺容量来分析数据，以比较大小不匹配的情况。
回顾性分析患者病历。将患者分为三组，第一组患者的供受者 pTLC 比值（DRPR）<1.0（肺移植供体大小过小组），第二组患者的 DRPR≥1.0 且<1.1（肺移植供体大小匹配组），第三组患者的 DRPR≥1.1（肺移植供体大小过大组）。使用卡方检验、克鲁斯卡尔-沃利斯检验以及 Kaplan-Meier 分析、竞争风险分析和多变量分析分别评估各组间的结果。
2010 年 1 月至 2023 年 5 月，在本机构接受移植的 1501 例患者中，有 422 例（28%）患者入组，其中 26 例（2%）患者为肺移植供体大小过大组（中位数 DRPR：1.14），101 例（7%）患者为肺移植供体大小匹配组（中位数 DRPR：1.03），296 例（20%）患者为肺移植供体大小过小组（中位数 DRPR：0.92）。与肺移植供体大小过小组相比，肺移植供体大小过大组患者在移植后 24（p<0.001）、48（p<0.001）和 72 小时（p=0.039）时的 PGD 分级 3 发生率更高，住院死亡率也更高（p=0.033）。与肺移植供体大小过大组和匹配组相比，肺移植供体大小过小组的长期生存率更好（p=0.011 和 p=0.01）。
肺纤维化患者肺移植供体大小超过 10%，会导致术后早期结果和长期生存率恶化。
