The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation

• Published in: The Journal of heart and lung transplantation Vol. 31; no. 5; pp. 492 - 500
• Main Authors: Eberlein, Michael, MD, PhD, Arnaoutakis, George J., MD, Yarmus, Lonny, DO, Feller-Kopman, David, MD, Dezube, Rebecca, MD, Chahla, Mayy F., MD, Bolukbas, Servet, MD, Reed, Robert M., MD, Klesney-Tait, Julia, MD, Parekh, Kalpaj R., MD, Merlo, Christian A., MD, Shah, Ashish S., MD, Orens, Jonathan B., MD, Brower, Roy G., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2012; Elsevier
• Subjects: Adult; airway complications; Baltimore; Biological and medical sciences; Cardiology. Vascular system; Female; Follow-Up Studies; Health Resources - utilization; Humans; Length of Stay; Lung - pathology; lung size mismatch; lung transplantation; Lung Transplantation - mortality; Lung Transplantation - pathology; Male; Medical sciences; Middle Aged; Organ Size; Prospective Studies; resource utilization; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Transplantation, Homologous; Baltimore; lung transplantation; lung size mismatch; resource utilization; airway complications; Incompatibility; Lung; Size; Resource; Bilateral; Transplantation; Homotransplantation; Phlebology; Treatment; Surgery; Graft; Complication; Circulatory system; Cardiology
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2011.12.009

Background Oversizing the lung allograft, as estimated by a donor-to-recipient predicted total lung capacity (pTLC) ratio > 1.0, was associated with improved long-term survival after lung transplantation (LTx) but could be associated with increased post-operative complications and higher resource utilization. Methods The prospectively maintained LTx database at The Johns Hopkins Hospital was retrospectively reviewed for bilateral LTx patients in the post-Lung Allocation Score (LAS) era. Patients were grouped by pTLC ratio ≤ 1.0 (undersized) or > 1.0 (oversized). Post-operative complications and hospital charges were analyzed. Results The pTLC ratio was available for 70 patients: 31 were undersized and 39 oversized. Undersized patients had a higher LAS (40.4 vs 35.8, p = 0.009), were more often in the intensive care unit (ICU) pre-LTx (35% vs 10%, p = 0.01), and had a higher occurrence of primary graft dysfunction (PGD; 25% vs 5%, p = 0.013) and tracheostomy (32% vs 10%, p = 0.02), longer index hospitalizations (20 [interquartile range (IQR), 10–46] vs 16 [IQR, 12–25] days, p = 0.048), and higher index hospitalization charges ($176,247 [IQR, $137,646–$284,012] vs $158,492 [IQR, $136,250–$191,301], p = 0.04). After adjusting for LAS and pre-LTx ICU stay, a lower pTLC ratio remained associated with higher hospital charges ( p = 0.049). Airway complications were more frequent and severe in undersized patients. Conclusion Oversized allografts were not associated with an increase in post-LTx complications. However, LTx recipients of undersized allografts were more likely to experience PGD, tracheostomy, and had higher resource utilization. Higher acuity in the undersized group might explain these findings; however, multivariate models suggest an independent association between undersizing, PGD, and resource utilization.