Purpose The ideal graft size match for lung transplantation (LTX) in patients with pulmonary fibrosis (IPF) is still unclear. Donor lungs are usually undersized to adapt to a smaller recipient's chest cavity. We investigated the functional, estimated and CT scan rendered volumes of donors and recipients of LTX. Methods and Materials Preoperarative estimated total lung capacity (rTLC-pre), estimated functional vital capacity (r-eFVC-pre), actual FVC (rFVC-pre) and CT scan lung volumetry (rCT-pre) were calculated in 96 patients with IPF who were listed for LTX. Estimated post-LTX TLC (eTLC-post), actual post LTX FVC (rFVC-post) and CT scan lung volumetry (rCT-post) were calculated in the recipients of LTX. Estimated TLC (dTLC) and FVC (dFVC) were calculated in 26 lung matched donors of IPF recipients. All the volumes are presented as mean values. Results Despite a trend towards matching smaller donors with larger recipients, dTLC and rTLC-pre did not differ significantly (5.53 vs. 5.57 liters, p=0.42). In the recipients, rCT-pre was significantly smaller than rTLC-pre (3.16 vs 5.53 lt, p<0.0001). Also, rFVC-pre was significantly smaller than r-eFVC-pre (1.87 vs. 3.47 lts, p<0.001). After the transplant, rCT-post was smaller than eTLC-post (3.02 vs.5.72 lts, p<0.001). Also, rCT was significantly smaller than dTLC (3.02 vs 5.57 lts, p<0.001), corresponding to a 45.3% volume reduction. rCT-pre and rCT-post did not differ significantly (3.09 vs.3.21 lts, p=0.61). rFVC-post increased compared to rFVC-pre by a factor of 18.08%. Conclusions The analysis of donor and pre/post LTX lung volumes (estimated, actual, and CT scan rendered) suggests that the pulmonary graft tends to adapt to the recipient small chest cavity. Given the acceptable functional results, this result could suggest the possibility of further reducing the donor/recipient volume ratio when matching lung donors to recipients, thus allowing expansion the donor pool.
Changes in Pulmonary Volumes in patients who underwent lung transplantation for pulmonary fibrosis
Bertani A;
2012-01-01
Abstract
Purpose The ideal graft size match for lung transplantation (LTX) in patients with pulmonary fibrosis (IPF) is still unclear. Donor lungs are usually undersized to adapt to a smaller recipient's chest cavity. We investigated the functional, estimated and CT scan rendered volumes of donors and recipients of LTX. Methods and Materials Preoperarative estimated total lung capacity (rTLC-pre), estimated functional vital capacity (r-eFVC-pre), actual FVC (rFVC-pre) and CT scan lung volumetry (rCT-pre) were calculated in 96 patients with IPF who were listed for LTX. Estimated post-LTX TLC (eTLC-post), actual post LTX FVC (rFVC-post) and CT scan lung volumetry (rCT-post) were calculated in the recipients of LTX. Estimated TLC (dTLC) and FVC (dFVC) were calculated in 26 lung matched donors of IPF recipients. All the volumes are presented as mean values. Results Despite a trend towards matching smaller donors with larger recipients, dTLC and rTLC-pre did not differ significantly (5.53 vs. 5.57 liters, p=0.42). In the recipients, rCT-pre was significantly smaller than rTLC-pre (3.16 vs 5.53 lt, p<0.0001). Also, rFVC-pre was significantly smaller than r-eFVC-pre (1.87 vs. 3.47 lts, p<0.001). After the transplant, rCT-post was smaller than eTLC-post (3.02 vs.5.72 lts, p<0.001). Also, rCT was significantly smaller than dTLC (3.02 vs 5.57 lts, p<0.001), corresponding to a 45.3% volume reduction. rCT-pre and rCT-post did not differ significantly (3.09 vs.3.21 lts, p=0.61). rFVC-post increased compared to rFVC-pre by a factor of 18.08%. Conclusions The analysis of donor and pre/post LTX lung volumes (estimated, actual, and CT scan rendered) suggests that the pulmonary graft tends to adapt to the recipient small chest cavity. Given the acceptable functional results, this result could suggest the possibility of further reducing the donor/recipient volume ratio when matching lung donors to recipients, thus allowing expansion the donor pool.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
