Lung Allograft Size Matching According to Actual, Corrected, and Predicted Total Lung Capacity for Patients With Pulmonary Fibrosis

Abstract Objectives Donor-recipient size matching in patients with pulmonary fibrosis may be performed according to the actual total lung capacity (aTLC) as measured by body plethysmography, the corrected total lung capacity (cTLC), and the predicted total lung capacity (pTLC). However, there is still no consensus on the ideal matching total lung capacity. Therefore, we aimed to analyse post-transplant outcomes of patients with pulmonary fibrosis listed according to aTLC, cTLC, or pTLC. Methods Patient records were retrospectively reviewed and analysed using Bayesian statistics. Patients with pulmonary fibrosis who underwent double lung transplantation without concomitant lung reduction surgery were included. Results Between November 2017 and May 2023, among the 521 patients who underwent lung transplantation at our institution, 122 (24%) were included, with 11 (9%) forming the aTLC group, 21 (17%) forming the cTLC group, and 90 (74%) forming the pTLC group. Overall patient and graft mortality was decreased in patients who were listed according to aTLC when compared to cTLC (HR 0.11; 95% CrI 0-0.99). However, Bayesian Cox multivariable analysis revealed that this was due to the higher incidence of associated pulmonary hypertension and chronic renal failure in the cTLC group. No difference was seen in the incidence of biopsy-confirmed rejection and chronic lung allograft dysfunction. Conclusions Our study showed that listing patients according to aTLC improved mortality when compared to listing according to cTLC, because patients listed according to cTLC had a higher preoperative morbidity.