Assessment of chest wall elastance in patients with pulmonary fibrosis waiting for lung transplantation, interest in donor size selection

Some patients with pulmonary fibrosis (PF) can have severe and fixed chest wall retraction; others regain the shape of their original rib cage once the lungs are removed. These 2 possibilities determine the size of the lung graft to be allocated but are not predictable with classical respiratory tests or computed tomography (CT) scan. We first measured chest wall elastance (E_cw) with esophageal pressure on the day of transplantation (group 1) and then during pretransplant medical check-up, and used for donor selection (group 2). Twenty patients in group 1 had low pretransplantation actual total lung capacity/predicted total lung capacity (pTLC) ratio that was not correlated with E_cw. The amount of transplanted lung TLC_transplanted/pTLC was correlated to E_cw (R² = 0.43, p = 0.003). Patient with higher E_cw required lung resection and had more primary graft dysfunction. In group 2, 20 patients' E_cw measurements allowed for increase in TLC_transplanted/pTLC from 79 ± 20% to 93 ± 18%, p = 0.023 with only 2 lung resections. E_cw can be measured before transplantation to optimize size mismatch and lung resection.