Catelli Chiara, D'Alessandro Miriana, Lloret Madrid Andrea, Fossi Antonella, Franchi Federico, Bennett David, Paladini Piero, Bargagli Elena, Luzzi Luca
Lung Transplant Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
Transpl Int. 2025 Apr 9;38:14387. doi: 10.3389/ti.2025.14387. eCollection 2025.
Lung transplantation is a life-saving procedure for end-stage lung diseases. Size matching is critical in the donor-recipient selection process. This retrospective study analyzed 146 patients who underwent lung transplantation between 2013 and 2023. Patients who required graft resizing were assigned to the sizing group (S), non-resizing cases to the non-sizing group (NS). The primary goal was to identify predictive factors for graft resizing. Secondary endpoints included ischemia time, ventilation time, primary graft dysfunction (PGD) and hospital stay. The S group was further stratified on baseline parameters to assess differences in outcomes. Recipient height and single transplants were higher in the NS group. Donor-recipient height ratio was the only predictor for resizing (p = 0.02). Postoperative outcomes and overall survival were similar between the groups. In Group S, male patients showed higher rates of acute kidney injury (AKI) and chronic rejection, the former being associated also with anatomical resections; patients older than 50 experienced higher rates of PGD. Graft resizing is a feasible strategy for addressing size mismatch, but it is associated with increased risks of PGD and AKI, particularly in older male recipients and those undergoing anatomical resections. These findings highlight the importance of careful preoperative donor-recipient size matching.
肺移植是终末期肺部疾病的一种挽救生命的手术。在供体-受体选择过程中，大小匹配至关重要。这项回顾性研究分析了2013年至2023年间接受肺移植的146例患者。需要调整移植物大小的患者被分配到调整大小组（S组），未调整大小的病例被分配到未调整大小组（NS组）。主要目标是确定移植物大小调整的预测因素。次要终点包括缺血时间、通气时间、原发性移植物功能障碍（PGD）和住院时间。S组根据基线参数进一步分层，以评估结果差异。NS组的受体身高和单肺移植比例更高。供体-受体身高比是大小调整的唯一预测因素（p = 0.02）。两组之间的术后结果和总体生存率相似。在S组中，男性患者急性肾损伤（AKI）和慢性排斥反应的发生率较高，前者也与解剖切除有关；50岁以上的患者PGD发生率较高。调整移植物大小是解决大小不匹配的一种可行策略，但它与PGD和AKI风险增加有关，特别是在老年男性受体和接受解剖切除的患者中。这些发现突出了术前仔细进行供体-受体大小匹配的重要性。
