Graft side-mismatching for single-lung transplantation does not affect outcomes: role of the pre-operative quantitative lung perfusion scan

J Heart Lung Transplant. 2008 Mar;27(3):272-5. doi: 10.1016/j.healun.2007.12.005.

Abstract

Background: There are concerns about which lung to explant during single-lung transplantation (SLT). Traditionally, a quantitative lung perfusion scan (QLPS) is performed, and the better-perfused lung is retained. Occasionally, there is transplantation with graft "side-mismatching," where the less-well-perfused lung is retained. We performed a retrospective study of patients undergoing SLT at our institution to evaluate the effects of side-mismatching (according to the QLPS) on graft performance and outcome.

Methods: We defined graft side-mismatching with a prospectively designed formula using baseline QLPS, and defined patients as either side-matched or side-mismatched. Data on mortality, requirement for cardiopulmonary bypass, relative graft perfusion, lung function and exercise capacity were obtained from institutional databases and patients' files.

Results: In a cohort of 114 patients, we defined 97 as having received a side-matched SLT and 17 as having received a side-mismatched graft. After lung transplantation, forced expiratory volume in 1 second (FEV(1)) and exercise capacity improved in both groups (p < 0.001). Patients with mismatched lungs had significantly higher relative graft perfusion post-operatively (p = 0.0012). There was no significant difference between the two groups (matched vs mismatched) in mortality, physiologic parameters and need for cardiopulmonary bypass.

Conclusions: There is no apparent risk to the patient when a side-mismatched lung graft is transplanted. We conclude that side-mismatched lung transplantation appears to be feasible when required.

MeSH terms

  • Aged
  • Cohort Studies
  • Exercise Tolerance / physiology
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Lung / anatomy & histology
  • Lung / diagnostic imaging
  • Lung / physiopathology*
  • Lung Transplantation / methods*
  • Lung Transplantation / physiology*
  • Male
  • Middle Aged
  • Perfusion
  • Prospective Studies
  • Radionuclide Imaging
  • Retrospective Studies
  • Treatment Outcome