Impact of lung resections on lung transplant grafts due to size discrepancy

Abstract

Background

Lung transplantation (LT) is a well-established therapeutic option for patients with advanced respiratory diseases. However, the impact of size discrepancy between donor and recipient remains controversial.

Objective

This study aims to evaluate the impact of lung graft volume reduction due to size mismatch between donor and recipient.

Methods

A retrospective analysis was conducted at a single reference center, including all LT procedures performed between January 1, 2015, and July 30, 2024. Surgical protocols were reviewed, and the need for graft volume reduction was recorded. The decision to perform graft reduction was made intraoperatively by the lead surgeon.

Results

A total of 420 patients were included. Lung graft resection was performed in 14 cases (3.3 %). Patients requiring graft resection had longer operative times, prolonged intubation and ICU stays, and increased tracheostomy requirements. The donor-to-recipient predicted total lung capacity (pTLC) ratio was significantly higher among patients requiring resection. While 5-year survival was not significantly different, 1- and 3-year survival rates were worse for patients requiring resection.

Conclusion

Lung graft resection due to donor-recipient size discrepancy can be a viable option for suitable recipients, although it is associated with increased postoperative morbidity. Given the small sample size (14 patients), these findings should be interpreted cautiously, and larger studies are needed to confirm these results. Early referral to transplant centers and careful donor-recipient matching are crucial to minimize the need for graft resection and improve outcomes.