Lung allograft size-matching according to actual, corrected and predicted total lung capacity for patients with pulmonary fibrosis

OBJECTIVES: Donor-recipient size matching in patients with pulmonary fibrosis may be performed according to the actual total lung capacity (aTLC) as measured by bodyplethysmography, the corrected total lung capacity (cTLC) and the predicted total lung capacity (pTLC). However, there is still no consensus on the ideal matching total lung capacity. Therefore, we aimed to analyze posttransplant outcomes of patients with pulmonary fibrosis listed according to aTLC, cTLC or pTLC. METHODS: Patient records were retrospectively reviewed and analyzed using Bayesian statistics. Patients with pulmonary fibrosis who underwent double lung transplantation without concomitant lung reduction surgery were included. RESULTS: Between November 2017 and May 2023, among the 521 patients who underwent lung transplantation at our institution, 122 (24%) were included, 11 (9%) forming the aTLC-group, 21 (17%) forming the cTLC-group and 90 (74%) forming the pTLC-group. Overall patient and graft mortality was decreased in patients who were listed according to aTLC when compared to cTLC (HR 0.11; 95% CrI 0-0.99). However, Bayesian Cox multivariable analysis revealed that this was due to the higher incidence of associated pulmonary hypertension and chronic renal failure in the cTLC group. No difference was seen in incidence of biopsy confirmed rejection and chronic lung allograft dysfunction. CONCLUSION: Our study showed that listing patients according to aTLC improved mortality when compared to listing according to cTLC, because patients listed according to cTLC had a higher preoperative morbidity.

• Franz, M.
• Mohssen, A.
• Aburahma, K.
• de Manna, N. D.
• Kruszona, S.
• Boethig, D.
• Alhadidi, H.
• Bobylev, D.
• Schwerk, N.
• Ruhparwar, A.
• Weymann, A.
• Kuehn, C.
• Warnecke, G.
• Greer, M.
• Salman, J.
• Ius, F.