Donor-recipient compatibility - Reduction of lung volume and lobar transplantation

Lung recipients are actually scheduled in the waiting list according to their weight and height; however, lung size changes in function of height, age, sex and race. Furthermore, these patients are frequently underweight, with a consequent size discrepancy between donors and recipients. We reviewed our experience with size matching between donors and recipients in 38 lung transplants. In 14 patients (9 bilateral and 5 single), pulmonary allografts were considered to be too large to fit into the recipient thoracic cavity. In 13 patients (9 bilateral and 5 single lung transplantation) the transplanted lungs were trimmed by extra anatomic wedge resections with mechanical staplers and bovine pericardium buttressing in order to reach an acceptable size in one case we performed a bilateral lobar transplantation since donor and recipient size was extremely different. Total Lung Capacity (TLC) of the donors and the recipients matched with lung volume reduction presented a 43% difference (4.4 L vs 6.3 L). No postoperative complications related to lung tailoring were observed. The only patient receiving a bilateral lobar transplantation died for primary graft failure. Moderate size disparities between donor and recipient lungs can be overcome with extra anatomic wedge resections. Lobar transplantation is an attractive mean in case of major size discrepancy.