Impact of Graft Mume Reduction for Oversized Grafts After Lung Transplantation on Outcome in Recipients With End-stage Restrictive Pulmonary Diseases

Background: Optimal size matching is critical to avoid problems from oversized grafts used in lung transplantation for restrictive pulmonary diseases in patients with a small chest cavity. Although graft volume reduction (GVR) is useful to overcome related disparities, its merits and demerits remain unclear. Methods: We performed 342 lung transplants during the period of January 2003 to April 2007. Of the lung transplant recipients, 167 recipients had end-stage restrictive pulmonary diseases, with 25 (15%) receiving grafts considered to be oversized because of height disparity. The present retrospective analysis was conducted to compare between patients with size-matched and oversized grafts, and patients who did (GVR group, n = 9) and did not (non-GVR group, n = 16) undergo GVR for an oversized graft. Results: Pulmonary functional improvement after 6 months was better in size-matched patients in view of percent forced vital capacity (FVC%) increase (29.8% vs 21.2%, P < 0.05), whereas long-term survival was not significantly different between the size-matched and oversized groups. Compared with the GVR group, the non-GVR group had a significantly higher incidence of short-term complications leading to respiratory failure (50% vs 11.1%, p < 0.05), whereas functional improvement was significantly worse in the non-GVR group (FVC% increase: 32.8% vs; 19.9%, p < 0.05). However, overall patient survival at 3 years was not significantly different (non-GVR: 67%; GVR: 75%). Conclusions: An oversized graft may lead to a higher incidence of short-term clinical complications with reduced pulmonary function improvement post-operatively in lung transplantation recipients with end-stage restrictive pulmonary diseases. The decision of whether to carry-out GVR at the time of transplantation with an oversized graft to improve outcome is of critical importance. J Heart Lung Transplant 2009;28:130-4. Copyright (C) 2009 by the International Society for Heart and Lung Transplantation.