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. 2023 Mar;55(2):432-439.
doi: 10.1016/j.transproceed.2023.02.016. Epub 2023 Mar 12.

Potential Role of Computed Tomography Volumetry in Size Matching in Lung Transplantation

Rodrigo Vazquez Guillamet  1 , Ashraf Rjob  2 , Andrew Bierhals  3 , Laneshia Tague  2 , Gary Marklin  2 , Laura Halverson  2 , Chad Witt  2 , Derek Byers  2 , Ramsey Hachem  2 , David Gierada  3 , Steven L Brody  4 , Tsuyoshi Takahashi  5 , Ruben Nava  5 , Daniel Kreisel  5 , Varun Puri  5 , Elbert P Trulock  2
Affiliations

Potential Role of Computed Tomography Volumetry in Size Matching in Lung Transplantation

Rodrigo Vazquez Guillamet et al. Transplant Proc. 2023 Mar.

Abstract

Background: Accumulated knowledge on the outcomes related to size mismatch in lung transplantation derives from predicted total lung capacity equations rather than individualized measurements of donors and recipients. The increasing availability of computed tomography (CT) makes it possible to measure the lung volumes of donors and recipients before transplantation. We hypothesize that CT-derived lung volumes predict a need for surgical graft reduction and primary graft dysfunction.

Methods: Donors from the local organ procurement organization and recipients from our hospital from 2012 to 2018 were included if their CT exams were available. The CT lung volumes and plethysmography total lung capacity were measured and compared with predicted total lung capacity using Bland Altman methods. We used logistic regression to predict the need for surgical graft reduction and ordinal logistic regression to stratify the risk for primary graft dysfunction.

Results: A total of 315 transplant candidates with 575 CT scans and 379 donors with 379 CT scans were included. The CT lung volumes closely approximated plethysmography lung volumes and differed from the predicted total lung capacity in transplant candidates. In donors, CT lung volumes systematically underestimated predicted total lung capacity. Ninety-four donors and recipients were matched and transplanted locally. Larger donor and smaller recipient lung volumes estimated by CT predicted a need for surgical graft reduction and were associated with higher primary graft dysfunction grade.

Conclusion: The CT lung volumes predicted the need for surgical graft reduction and primary graft dysfunction grade. Adding CT-derived lung volumes to the donor-recipient matching process may improve recipients' outcomes.

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Conflict of interest statement

DISCLOSURES The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1.
Fig 1.
Population flow chart, the red box on the left includes candidates (A), the green box on the right includes donors (B), and the bubble over the red and green boxes includes the matched cohort.
Fig 2.
Fig 2.
Scatter plot comparing computed tomography and plethysmography lung volumes to predicted total lung capacity according to the global lung function initiative equations in candidates for lung transplantation. The unit of measurement is liters. CT, computed tomography; TLC, total lung capacity.
Fig 3.
Fig 3.
Scatter plot comparing computed tomography-derived lung volumes in donors to predicted total lung capacity according to the global lung function initiative equations. The unit of measurement is liters. CT, computed tomography; LLN, lower limit of normal; pTLC, predicted total lung capacity; TLC, total lung capacity; ULN, upper limit of normal.
Fig 4.
Fig 4.
Predicted probabilities for each primary graft dysfunction grade with 95% CIs on the vertical axis according to recipient computed tomography lung volume in liters on the horizontal axis for a donor with the mean computed tomography lung volume of 2.8 liters.
Fig 5.
Fig 5.
Donor computed tomography lung volumes on the vertical axis with the corresponding recipient computed tomography lung volumes to achieve a 30%, 25%, 20%, and 15% risk of primary graft dysfunction grade 2 and 3.
See this image and copyright information in PMC

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