Impact of graft volume reduction for oversized grafts after lung transplantation on outcome in recipients with end-stage restrictive pulmonary diseases

J Heart Lung Transplant. 2009 Feb;28(2):130-4. doi: 10.1016/j.healun.2008.11.003.

Abstract

Background: Optimal size matching is critical to avoid problems from oversized grafts used in lung transplantation for restrictive pulmonary diseases in patients with a small chest cavity. Although graft volume reduction (GVR) is useful to overcome related disparities, its merits and demerits remain unclear.

Methods: We performed 342 lung transplants during the period of January 2003 to April 2007. Of the lung transplant recipients, 167 recipients had end-stage restrictive pulmonary diseases, with 25 (15%) receiving grafts considered to be oversized because of height disparity. The present retrospective analysis was conducted to compare between patients with size-matched and oversized grafts, and patients who did (GVR group, n = 9) and did not (non-GVR group, n = 16) undergo GVR for an oversized graft.

Results: Pulmonary functional improvement after 6 months was better in size-matched patients in view of percent forced vital capacity (FVC%) increase (29.8% vs 21.2%, p < 0.05), whereas long-term survival was not significantly different between the size-matched and oversized groups. Compared with the GVR group, the non-GVR group had a significantly higher incidence of short-term complications leading to respiratory failure (50% vs 11.1%, p < 0.05), whereas functional improvement was significantly worse in the non-GVR group (FVC% increase: 32.8% vs 19.9%, p < 0.05). However, overall patient survival at 3 years was not significantly different (non-GVR: 67%; GVR: 75%).

Conclusions: An oversized graft may lead to a higher incidence of short-term clinical complications with reduced pulmonary function improvement post-operatively in lung transplantation recipients with end-stage restrictive pulmonary diseases. The decision of whether to carry-out GVR at the time of transplantation with an oversized graft to improve outcome is of critical importance.

MeSH terms

  • Adult
  • Aged
  • Blood Pressure
  • Body Height
  • Female
  • Forced Expiratory Volume
  • Humans
  • Lung / anatomy & histology*
  • Lung Diseases / epidemiology*
  • Lung Transplantation / adverse effects
  • Lung Transplantation / methods*
  • Lung Transplantation / physiology
  • Male
  • Middle Aged
  • Organ Size
  • Postoperative Complications / epidemiology
  • Respiratory Function Tests
  • Retrospective Studies
  • Sex Characteristics
  • Tissue Donors / statistics & numerical data
  • Vital Capacity