Donor–Recipient Size Matching and Survival after Lung Transplantation. A Cohort Study
- 1 October 2013
- journal article
- Published by American Thoracic Society in Annals of the American Thoracic Society
- Vol. 10 (5), 418-425
- https://doi.org/10.1513/annalsats.201301-008oc
Abstract
The association between a high predicted total lung capacity (pTLC) ratio (equal to pTLC(donor)/pTLC(recipient)), suggestive of an oversized allograft, with improved survival after lung transplantation (LTx) remains controversial. To characterize donor-recipient lung size matching based on the pTLC ratio and to investigate the relationship of the pTLC ratio with post-LTx survival. All subjects in the Scientific Registry of Transplant Recipients, who underwent first-time LTx in the lung allocation score-based system between May 4, 2005 and March 31, 2012, were studied, and the pTLC ratio was calculated on the basis of sex, height, and age. Risk of death after LTx was analyzed using Cox proportional hazards models. The pTLC ratio was available for 10,289 of the 10,318 study subjects (99.7%). The mean pTLC ratio was 1.015 ± 0.175 (interquartile range, 0.918-1.119). Univariate analysis showed that the pTLC ratio was strongly associated with death in the first LTx year (P < 0.0001). With the pTLC ratio entered as a spline there was a nonlinear association with declining risk of death with higher pTLC ratio from 0.5 to about 1.3, where an inflection occurred with rising risk at higher values. Accounting for the pTLC ratio, recipient and donor sex were not independently associated with death after LTx. A change of pTLC ratio from 0.918 to 1.119 (the interquartile range) was associated with similar point estimates of reduced risk of death at 1 year in univariate (hazard ratio, 0.78) and comprehensive risk-adjusted multivariate models (hazard ratio, 0.86). The pTLC ratio is an independent predictor of death in the first year after LTx and explains the association of sex with survival after LTx. Incorporating the pTLC ratio in the lung allocation mechanism could improve outcomes after LTx.Keywords
This publication has 24 references indexed in Scilit:
- Lung Size Mismatch and Survival After Single and Bilateral Lung TransplantationThe Annals of Thoracic Surgery, 2013
- Parameters of donor–recipient size mismatch and survival after bilateral lung transplantationThe Journal of Heart and Lung Transplantation, 2012
- The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantationThe Journal of Heart and Lung Transplantation, 2012
- Lung Size Mismatch in Bilateral Lung Transplantation Is Associated With Allograft Function and Bronchiolitis Obliterans SyndromeSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Lung and Heart-Lung Transplant Report—2011The Journal of Heart and Lung Transplantation, 2011
- Supranormal Expiratory Airflow after Bilateral Lung Transplantation Is Associated with Improved SurvivalAmerican Journal of Respiratory and Critical Care Medicine, 2011
- Matching donor to recipient in lung transplantation: How much does size matter?The Journal of Thoracic and Cardiovascular Surgery, 2009
- The Effect of Gender Combinations on Outcome in Human Lung Transplantation: The International Society of Heart and Lung Transplantation Registry ExperienceThe Journal of Heart and Lung Transplantation, 2006
- Influence of Donor Characteristics on Outcome After Lung Transplantation: A Multicenter StudyThe Journal of Heart and Lung Transplantation, 2005
- Modeling Survival Data: Extending the Cox ModelPublished by Springer Science and Business Media LLC ,2000