Chest
Original ResearchTransplantationLung Size Mismatch in Bilateral Lung Transplantation Is Associated With Allograft Function and Bronchiolitis Obliterans Syndrome
Section snippets
Materials and Methods
This study was approved by the institutional review boards at the sites involved (e-Appendix 1A). We analyzed all BLTs for adult patients performed at Johns Hopkins Hospital from January 1, 1996, to March 1, 2010, and all BLTs performed at Inova Fairfax Hospital from January 1, 1996, to December 31, 2008. Recipients of single lung transplants were not assessed because of the potential effect of the native lung on overall lung function. All adult patients who received BLTs and were alive 3
Characteristics of the Stud
There were 159 adult patients who qualified for the analysis, of whom 154 received a BLT and five a heart-lung transplant (HLT). Donor and recipient characteristics are shown in Table 1. The follow-up period was completed at time of death or August 1, 2010, with a median follow-up period of 2.6 years (range, 0.3-14.2 years). The dataset included 3,783 FVL observations. The mean pTLC ratio for the study population was 1.06 ± 0.17. Patients who received transplants for COPD had the highest mean
Discussion
In this investigation of lung size mismatch and allograft function, a pTLC ratio > 1.0, suggestive of an oversized allograft, was associated with higher expiratory airflow capacity and a less frequent occurrence of BOS. A higher pTLC ratio was associated with a lower FVC, expressed as % predicted of donor lung. Expressing allograft function in relation to donor predicted lung function likely captured the actual restriction of an oversized allograft in a smaller recipient's thorax.
Prior studies
Conclusion
An oversized allograft is associated with higher expiratory airflow and lower occurrence of BOS. The oversized cohort is conceptually similar to CWS, an experimental condition known to cause higher expiratory airflow, likely from changes in surface tension. The mechanism linking an oversized allograft to delayed occurrence of BOS deserves further investigation.
Acknowledgments
Author contributions: Dr Eberlein is the guarantor of the entire manuscript.
Dr Eberlein: contributed to the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and the revision of the article for important intellectual content.
Dr Permutt: contributed to the conception and design of the study, analysis and interpretation of data, and the revision of the article for important intellectual content.
Dr Chahla: contributed to the
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
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Dr Eberlein is currently at the Carver College of Medicine, University of Iowa, Iowa City, Iowa.