Sizing in lung transplantation: principles, practices and ideas for the future
Lung transplantation (LTx) is an important treatment option for many end-stage lung diseases. The goal of LTx is to restore pulmonary physiology (gas exchange and respiratory system mechanics) towards normal, so that LTx recipients can experience an improved quality of life and live significantly lo...
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Elsevier
2025-08-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000990 |
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| author | Michael Eberlein Robert M. Reed Eric Abston Roy Brower Matthew G. Hartwig Yu Xia Daniel P. McCarthy |
| author_facet | Michael Eberlein Robert M. Reed Eric Abston Roy Brower Matthew G. Hartwig Yu Xia Daniel P. McCarthy |
| author_sort | Michael Eberlein |
| collection | DOAJ |
| description | Lung transplantation (LTx) is an important treatment option for many end-stage lung diseases. The goal of LTx is to restore pulmonary physiology (gas exchange and respiratory system mechanics) towards normal, so that LTx recipients can experience an improved quality of life and live significantly longer. An optimized approach to donor-to-recipient size matching is a strategy to increase opportunities for successful transplants and optimize outcomes. In this review we discuss relevant pulmonary gas exchange and respiratory systems mechanics principles as a framework to optimize donor-to-recipient size matching and LTX-recipient management. The predicted total lung capacity (pTLC) is a refined estimate of organ size utilizing regression equations to calculate lung size based on height, sex and age. In general, irrespective of the underlying lung disease the chest cavity is “reverse remolding” back towards normal size in most recipients. The parameter that can reflect the sizing goal to restore physiology towards normal is the recipient pTLC. A pragmatic size matching metric is the donor-to-recipient pTLC-ratio. Significant undersizing based on the pTLC-ratio is a risk factor for complications and lower LTx survival. If significant changes to the LTx candidate’s chest cavity size occur (as can occur in severe restrictive lung disease or severe emphysema), or if the chest cavity cannot “reverse remodel” towards normal, it is important to consider additional donor-to-recipient sizing metrics. In addition to the recipient’s measured actual total lung capacity imaging-based metrics can be considered. Chest X-ray and computer tomography based volumetric analyses can provide information facilitating a successful LTx. |
| format | Article |
| id | doaj-art-510ba3a151b843ecb83ec8a35d1551ad |
| institution | DOAJ |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-510ba3a151b843ecb83ec8a35d1551ad2025-08-20T03:02:59ZengElsevierJHLT Open2950-13342025-08-01910030410.1016/j.jhlto.2025.100304Sizing in lung transplantation: principles, practices and ideas for the futureMichael Eberlein0Robert M. Reed1Eric Abston2Roy Brower3Matthew G. Hartwig4Yu Xia5Daniel P. McCarthy6Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin-Madison, Madison, WI; Corresponding author: Michael Eberlein MD PhD, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin-Madison, Madison, WI 53706. Telephone: 608-890-4228.Division of Critical Care Medicine, George Washington University, Sinai Hospital of Baltimore, Baltimore, MDMassachusetts General Hospital, Division of Thoracic Surgery, Boston, MADivision of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MDDivision of Cardiovascular and Thoracic Surgery, Duke University, Durham, NCDivsion of Cardiothoracic Surgery, University of Wisconsin-Madison, Madison, WIDivsion of Cardiothoracic Surgery, University of Wisconsin-Madison, Madison, WILung transplantation (LTx) is an important treatment option for many end-stage lung diseases. The goal of LTx is to restore pulmonary physiology (gas exchange and respiratory system mechanics) towards normal, so that LTx recipients can experience an improved quality of life and live significantly longer. An optimized approach to donor-to-recipient size matching is a strategy to increase opportunities for successful transplants and optimize outcomes. In this review we discuss relevant pulmonary gas exchange and respiratory systems mechanics principles as a framework to optimize donor-to-recipient size matching and LTX-recipient management. The predicted total lung capacity (pTLC) is a refined estimate of organ size utilizing regression equations to calculate lung size based on height, sex and age. In general, irrespective of the underlying lung disease the chest cavity is “reverse remolding” back towards normal size in most recipients. The parameter that can reflect the sizing goal to restore physiology towards normal is the recipient pTLC. A pragmatic size matching metric is the donor-to-recipient pTLC-ratio. Significant undersizing based on the pTLC-ratio is a risk factor for complications and lower LTx survival. If significant changes to the LTx candidate’s chest cavity size occur (as can occur in severe restrictive lung disease or severe emphysema), or if the chest cavity cannot “reverse remodel” towards normal, it is important to consider additional donor-to-recipient sizing metrics. In addition to the recipient’s measured actual total lung capacity imaging-based metrics can be considered. Chest X-ray and computer tomography based volumetric analyses can provide information facilitating a successful LTx.http://www.sciencedirect.com/science/article/pii/S2950133425000990Lung transplantationSizingMatchingDonorLung physiology |
| spellingShingle | Michael Eberlein Robert M. Reed Eric Abston Roy Brower Matthew G. Hartwig Yu Xia Daniel P. McCarthy Sizing in lung transplantation: principles, practices and ideas for the future JHLT Open Lung transplantation Sizing Matching Donor Lung physiology |
| title | Sizing in lung transplantation: principles, practices and ideas for the future |
| title_full | Sizing in lung transplantation: principles, practices and ideas for the future |
| title_fullStr | Sizing in lung transplantation: principles, practices and ideas for the future |
| title_full_unstemmed | Sizing in lung transplantation: principles, practices and ideas for the future |
| title_short | Sizing in lung transplantation: principles, practices and ideas for the future |
| title_sort | sizing in lung transplantation principles practices and ideas for the future |
| topic | Lung transplantation Sizing Matching Donor Lung physiology |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000990 |
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