David P. Mason, MD, Lillian H. Batizy, MS, Jeffrey Wu, MD, Edward R

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Presentation transcript:

Matching donor to recipient in lung transplantation: How much does size matter? David P. Mason, MD, Lillian H. Batizy, MS, Jeffrey Wu, MD, Edward R. Nowicki, MD, MS, Sudish C. Murthy, MD, PhD, Ann M. McNeill, RN, Marie M. Budev, DO, Atul C. Mehta, MD, Gösta B. Pettersson, MD, PhD, Eugene H. Blackstone, MD The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 5, Pages 1234-1240.e1 (May 2009) DOI: 10.1016/j.jtcvs.2008.10.024 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Distribution of differences in aTLC versus pTLC by diagnosis. PAH, Pulmonary arterial hypertension; IPF, idiopathic pulmonary fibrosis; aTLC, actual total lung capacity; pTLC, predicted total lung capacity. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1234-1240.e1DOI: (10.1016/j.jtcvs.2008.10.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Cumulative distribution of donor-to-recipient TLC according to diagnosis. A, Donor-to-recipient pTLCRatio. B, Donor-to-recipient aTLCRatio. IPF, Idiopathic pulmonary fibrosis; pTLCRatio, donor-to-recipient predicted total lung capacity ratio; aTLCRatio, donor-to-recipient actual total lung capacity ratio. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1234-1240.e1DOI: (10.1016/j.jtcvs.2008.10.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Overall unadjusted survival by terciles of donor-to-recipient pTLCRatio. Symbols represent deaths. Vertical bars represent 68% confidence limits equivalent to ± 1 standard error. Numbers in parentheses represent patients remaining at risk (P [log-rank] = .4). o = patients with largest 15% of pTLCRatio. • = patients with the middle 70% of pTLCRatio. □ = patients with the smallest 15% of pTLCRatio. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1234-1240.e1DOI: (10.1016/j.jtcvs.2008.10.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Unadjusted survival in patients with emphysema stratified by donor-to-recipient aTLCRatio. o = patients with extreme values of aTLCRatio (n = 44). □ = the 70% of patients with more typical values (n = 108). Format is as in Figure 3. P (Wilcoxon) = .01. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1234-1240.e1DOI: (10.1016/j.jtcvs.2008.10.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Predicted mean FEV1% after lung transplantation for emphysema from multivariable model of Table 4. A, Individual curves represent specific values of donor-to-recipient pTLCRatio. B, Individual curves represent specific values of donor-to-recipient aTLCRatio. FEV1%, Forced expiratory volume in 1 second; pTLCRatio, donor-to-recipient predicted total lung capacity ratio; aTLCRatio, donor-to-recipient actual total lung capacity ratio. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1234-1240.e1DOI: (10.1016/j.jtcvs.2008.10.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Predicted mean FEV1% after lung transplantation for IPF from multivariable model of Table 4. A, Individual curves represent specific values of donor-to-recipient pTLCRatio. B, Individual curves represent specific values of donor-to-recipient aTLCRatio. FEV1%, Forced expiratory volume in 1 second; pTLCRatio, donor-to-recipient predicted total lung capacity ratio; aTLCRatio, donor-to-recipient actual total lung capacity ratio. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1234-1240.e1DOI: (10.1016/j.jtcvs.2008.10.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Predicted mean FEV1% after lung transplantation for bronchiectasis from multivariable model of Table 4. A, Individual curves represent specific values of donor-to-recipient pTLCRatio. B, Individual curves represent specific values of donor-to-recipient aTLCRatio. FEV1%, Forced expiratory volume in 1 second; pTLCRatio, donor-to-recipient predicted total lung capacity ratio; aTLCRatio, donor-to-recipient actual total lung capacity ratio. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1234-1240.e1DOI: (10.1016/j.jtcvs.2008.10.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Number of patients with spirometry measurements available at and beyond various time points, and number of spirometry measurements available for analysis (black bars, spirometry measurements; grey bars, patients). The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1234-1240.e1DOI: (10.1016/j.jtcvs.2008.10.024) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions