Donor-recipient Size Matching Research Articles

496 MRI Validated Echocardiographic Technique To Measure Total Cardiac Volume: A Tool for Donor Recipient Size Matching

496 MRI Validated Echocardiographic Technique To Measure Total Cardiac Volume: A Tool for Donor Recipient Size Matching

Sources of graft restriction after single lung transplantation for emphysema

After single lung transplantation for emphysema, the volume of the graft at total lung capacity is usually less than its predicted volume in the donor. We sought to determine the contributions of donor-recipient size matching, postoperative native lung hyperinflation, and postoperative chest wall volume reduction to graft restriction after transplantation. In 19 patients, we estimated individual lung volumes from thoracic computed tomographs taken near total lung capacity before and after single lung transplantation for emphysema to analyze sources of graft restriction. Pulmonary function was assessed by spirometry, and in 5 patients, inspiratory function was assessed with esophageal manometry. Graft volumes after transplantation were 54% +/- 17% of those predicted for the donors (mean +/- SD, P < .0001), and pulmonary function after transplantation was significantly correlated with graft volume. The greatest contribution to graft restriction was the decrease in chest wall volume after transplantation, which was -0.87 L (-31% +/- 29% of the graft's predicted volume; P < .0001). Volume expansion of the contralateral lung contributed -0.44 L (-18% +/- 24%; P = .0018). Other effects, including donor-patient size matching, were not significant. In 5 patients, the maximum negative inspiratory esophageal pressure at total lung capacity was low (-6 +/- 2 cm H2O, normal range approximately -17 to -29 cm H2O). After single lung transplantation for emphysema, decreased volume of the chest wall was more important than increased volume of the native lung in causing restriction of the graft and decreased pulmonary function. Chest wall restriction is likely due to diminished inspiratory muscle function.

Donor Selection for Single and Double Lung Transplantation: Chest Size Matching and Other Factors Influencing Posttransplantation Vital Capacity

In six single lung transplant (SLT) and six double lung transplant (DLT) recipients, the relationships of the recipient's posttransplantation vital capacity (posttx VCR) to the recipient's predicted normal vital capacity (pred VCR) and the donor's predicted normal vital capacity (pred VCD) were investigated. After left SLT the left posttx VCR was correlated with the left predicted VCD (r = 0.83; p less than 0.05); however, no correlation was found between these after DLT. In contrast, there was a tendency toward correlation between the posttx VCR and the predicted VCR after DLT (r = 0.75; p less than 0.1), but no such trend was apparent after SLT. These results suggest that posttx VCR depends primarily on predicted VCD after SLT and on pred VCR after DLT. Therefore, in donor-recipient size matching for lung transplantation a donor with a pred VCD greater than the pred VCR should be chosen for a left SLT recipient, whereas a donor with a pred VCD near the pred VCR would be suitable for a DLT recipient.