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Computed Tomography Volumetrics for Size Matching in Lung Transplantation for Restrictive Disease.

Publication ,  Journal Article
Prabhu, NK; Wong, MK; Klapper, JA; Haney, JC; Mazurowski, MA; Mammarappallil, JG; Hartwig, MG
Published in: Ann Thorac Surg
February 2024

BACKGROUND: There is no consensus on the optimal allograft sizing strategy for lung transplantation in restrictive lung disease. Current methods that are based on predicted total lung capacity (pTLC) ratios do not account for the diminutive recipient chest size. The study investigators hypothesized that a new sizing ratio incorporating preoperative recipient computed tomographic lung volumes (CTVol) would be associated with postoperative outcomes. METHODS: A retrospective single-institution study was conducted of adults undergoing primary bilateral lung transplantation between January 2016 and July 2020 for restrictive lung disease. CTVol was computed for recipients by using advanced segmentation software. Two sizing ratios were calculated: pTLC ratio (pTLCdonor/pTLCrecipient) and a new volumetric ratio (pTLCdonor/CTVolrecipient). Patients were divided into reference, oversized, and undersized groups on the basis of ratio quintiles, and multivariable models were used to assess the effect of the ratios on primary graft dysfunction and survival. RESULTS: CTVol was successfully acquired in 218 of 220 (99.1%) patients. In adjusted analysis, undersizing on the basis of the volumetric ratio was independently associated with decreased primary graft dysfunction grade 2 or 3 within 72 hours (odds ratio, 0.42; 95% CI, 0.20-0.87; P =.02). The pTLC ratio was not significantly associated with primary graft dysfunction. Oversizing on the basis of the volumetric ratio was independently associated with an increased risk of death (hazard ratio, 2.27; 95% CI, 1.04-4.99; P =.04], whereas the pTLC ratio did not have a significant survival association. CONCLUSIONS: Using computed tomography-acquired lung volumes for donor-recipient size matching in lung transplantation is feasible with advanced segmentation software. This method may be more predictive of outcome compared with current sizing methods, which use gender and height only.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

February 2024

Volume

117

Issue

2

Start / End Page

413 / 421

Location

Netherlands

Related Subject Headings

  • Tomography, X-Ray Computed
  • Tissue Donors
  • Retrospective Studies
  • Respiratory System
  • Primary Graft Dysfunction
  • Organ Size
  • Lung Transplantation
  • Lung Diseases
  • Lung
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Prabhu, N. K., Wong, M. K., Klapper, J. A., Haney, J. C., Mazurowski, M. A., Mammarappallil, J. G., & Hartwig, M. G. (2024). Computed Tomography Volumetrics for Size Matching in Lung Transplantation for Restrictive Disease. Ann Thorac Surg, 117(2), 413–421. https://doi.org/10.1016/j.athoracsur.2023.03.033
Prabhu, Neel K., Megan K. Wong, Jacob A. Klapper, John C. Haney, Maciej A. Mazurowski, Joseph G. Mammarappallil, and Matthew G. Hartwig. “Computed Tomography Volumetrics for Size Matching in Lung Transplantation for Restrictive Disease.Ann Thorac Surg 117, no. 2 (February 2024): 413–21. https://doi.org/10.1016/j.athoracsur.2023.03.033.
Prabhu NK, Wong MK, Klapper JA, Haney JC, Mazurowski MA, Mammarappallil JG, et al. Computed Tomography Volumetrics for Size Matching in Lung Transplantation for Restrictive Disease. Ann Thorac Surg. 2024 Feb;117(2):413–21.
Prabhu, Neel K., et al. “Computed Tomography Volumetrics for Size Matching in Lung Transplantation for Restrictive Disease.Ann Thorac Surg, vol. 117, no. 2, Feb. 2024, pp. 413–21. Pubmed, doi:10.1016/j.athoracsur.2023.03.033.
Prabhu NK, Wong MK, Klapper JA, Haney JC, Mazurowski MA, Mammarappallil JG, Hartwig MG. Computed Tomography Volumetrics for Size Matching in Lung Transplantation for Restrictive Disease. Ann Thorac Surg. 2024 Feb;117(2):413–421.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

February 2024

Volume

117

Issue

2

Start / End Page

413 / 421

Location

Netherlands

Related Subject Headings

  • Tomography, X-Ray Computed
  • Tissue Donors
  • Retrospective Studies
  • Respiratory System
  • Primary Graft Dysfunction
  • Organ Size
  • Lung Transplantation
  • Lung Diseases
  • Lung
  • Humans