Optimizing Short Stature Patients Access to Transplantation through Surgical Downsizing of Donor Lungs

Purpose Due to donor/recipient size matching challenges, lung transplant candidates height may pose a significant disadvantage for receiving a transplant, resulting in longer wait times and increased waitlist mortality. We hypothesize that a proactive approach focused on donor lung size reduction improves access to transplantation with equivalent post-operative outcomes. Methods We retrospectively reviewed our experience with transplant candidates listed from Jan 2010 to May 2019. Since January 2016, our program considers surgical downsizing of donor lungs via non-anatomical reduction or lobar transplantation whenever LAS prioritization recommends matching to a shorter stature candidate and downsizing is anatomically feasible. We compared this cohort of patients (recent era) to those from our early era in which size reduction was not proactively performed (Jan 2010- Dec 2015). We excluded pediatric, redo and multiorgan transplants. Our primary endpoint was waitlist mortality or removal due to clinical deterioration. Secondary endpoints were time to transplant and post-operative outcomes. Results We included 410 patients with 226 in the early era and 184 in the recent era. Age (mean 54.46 vs 57.87) and LAS (mean 44.73 vs 44.18) were comparable between both groups. Donor characteristics were similar between periods. The number of patients with surgically downsized grafts was significantly higher in the current period compared to the early period (n=62; 34.4% vs n=20; 8.9%; p Conclusion Removal of size restrictions through proactive surgical downsizing improved access to transplantation. Despite more technically demanding, this change in practice has not impacted postoperative outcomes. The significant decreases in waitlist mortality and wait times suggest that this approach is able to address a significant disparity in our field.