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Transplant size mismatch in restrictive lung disease.

Publication ,  Journal Article
Ganapathi, AM; Mulvihill, MS; Englum, BR; Speicher, PJ; Gulack, BC; Osho, AA; Yerokun, BA; Snyder, LR; Davis, D; Hartwig, MG
Published in: Transpl Int
April 2017

To maximize the benefit of lung transplantation, the effect of size mismatch on survival in lung transplant recipients with restrictive lung disease (RLD) was examined. All single and bilateral RLD lung transplants from 1987 to 2011 in the United Network for Organ Sharing (UNOS) Database were identified. Donor predicted total lung capacity (pTLC):Recipient pTLC ratio (pTLCr) quantified mismatch. pTLCr was segregated into five strata. A Cox proportional hazards model evaluated the association of pTLCr with mortality hazard. To identify a critical pTLCr, a Cox model using a restricted cubic spline for pTLCr was used. A total of 6656 transplants for RLD were identified. Median pTLCr for single orthotopic lung transplant (SOLT) and bilateral orthotopic lung transplant (BOLT) was 1.0 (0.69-1.47) and 0.98 (0.66-1.45). Examination of pTLCr as a categorical variable revealed that undersizing (pTLCr <0.8) for SOLT and moderate oversizing (pTLCr = 1.1-1.2) for SOLT and BOLT had a harmful survival effect [for SOLT pTLC <0.8: HR 1.711 (95% CI 1.146-2.557), P = 0.01 and for BOLT pTLC 1.1-1.2: HR 1.717 (95% CI 1.112-2.651), P = 0.02]. Spline analysis revealed significant changes in SOLT mortality by variation of pTLCr between 0.8-0.9 and 1.1-1.2. RLD patients undergoing SOLT are susceptible to detriments of an undersized lung. RLD patients undergoing BOLT have higher risk of mortality when pTLCr falls between 1.1 and 1.2.

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Published In

Transpl Int

DOI

EISSN

1432-2277

Publication Date

April 2017

Volume

30

Issue

4

Start / End Page

378 / 387

Location

Switzerland

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Total Lung Capacity
  • Tissue Donors
  • Surgery
  • Retrospective Studies
  • Proportional Hazards Models
  • Organ Size
  • Middle Aged
  • Male
 

Citation

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Ganapathi, A. M., Mulvihill, M. S., Englum, B. R., Speicher, P. J., Gulack, B. C., Osho, A. A., … Hartwig, M. G. (2017). Transplant size mismatch in restrictive lung disease. Transpl Int, 30(4), 378–387. https://doi.org/10.1111/tri.12913
Ganapathi, Asvin M., Michael S. Mulvihill, Brian R. Englum, Paul J. Speicher, Brian C. Gulack, Asishana A. Osho, Babatunde A. Yerokun, Laurie R. Snyder, Duane Davis, and Matthew G. Hartwig. “Transplant size mismatch in restrictive lung disease.Transpl Int 30, no. 4 (April 2017): 378–87. https://doi.org/10.1111/tri.12913.
Ganapathi AM, Mulvihill MS, Englum BR, Speicher PJ, Gulack BC, Osho AA, et al. Transplant size mismatch in restrictive lung disease. Transpl Int. 2017 Apr;30(4):378–87.
Ganapathi, Asvin M., et al. “Transplant size mismatch in restrictive lung disease.Transpl Int, vol. 30, no. 4, Apr. 2017, pp. 378–87. Pubmed, doi:10.1111/tri.12913.
Ganapathi AM, Mulvihill MS, Englum BR, Speicher PJ, Gulack BC, Osho AA, Yerokun BA, Snyder LR, Davis D, Hartwig MG. Transplant size mismatch in restrictive lung disease. Transpl Int. 2017 Apr;30(4):378–387.
Journal cover image

Published In

Transpl Int

DOI

EISSN

1432-2277

Publication Date

April 2017

Volume

30

Issue

4

Start / End Page

378 / 387

Location

Switzerland

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Total Lung Capacity
  • Tissue Donors
  • Surgery
  • Retrospective Studies
  • Proportional Hazards Models
  • Organ Size
  • Middle Aged
  • Male