Total lung capacity size matching in fibrosis lung transplantation

Single (S) or bilateral (B) lung transplantation (LT) is offered for end stage, life-threatening pulmonary fibrosis (PF). Currently, no strong recommendation helps transplantation teams for choosing optimal total lung capacity (TLC) for size matching. We conducted a retrospective analysis of all LT performed in PF patients from 1988 to 2015 in Nantes University hospital, France, in order to study donor vs. recipient TLC. We defined transplanted BLT-TLC as follows: theoretic donor TLC minus lung volume surgical reduction, divided by theoretic recipient TLC. Transplanted SLT-TLC was similarly calculated, taking into account measured TLC of the remaining lung. 24 patients (46 ± 9 years, 10 SLT and 14 BLT) were included. Survival after transplantation for BLT, SLT and both was respectively 35.7%, 50% and 41.7% at 1 year, 21.5%, 10% and 16.7% at 5 years, with a median survival of 347 days for BLT and 272 days for SLT (p=0.38). Mean transplanted TLC was higher in BLT (86.4 ± 20.2% pred.) than in SLT (65.1 ± 7.2% pred.) (p = 0.007) and higher than recipient TLC measured / theoretic in BLT (54 ± 22%) and SLT (48 ± 10%) (p=0.038). Average lung volume reduction was 12.3% in BLT and was performed in 35.7% of BLT and 20% of SLT. When classifying patients according to different thresholds of transplanted TLC percentage (70% or 80% pred.), no mortality difference was observed in SLT, BLT or both groups. Taking into account surgical lung volume reduction, we report a lower transplanted TLC in BLT and SLT than the one suggested by Barnard et al. (Barnard J.B, J Heart Tranplant 2013;32:849-860). The best TLC size matching appears to be somewhere between measured and theoretic TLC recipient but has to be further explored.