Donor to recipient sizing in thoracic organ transplantation

作     者：Michael Eberlein Robert M Reed 

作者机构：Division of Pulmonary Critical Care and Occupational Medicine University of Iowa Hospitals and Clinics Division of Pulmonary and Critical Care Medicine University of Maryland 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2016年第6卷第1期

页      面：155-164页

学科分类：10[医学] 

基　　金：Supported by Flight Attendants Medical Research Institute in part(to Robert M Reed) Michael Eberlein is supported by a PILOT grant from the Institute for Clinical and Translational Science(ICTS)at the University of Iowa via the National Institutes of Health(NIH)Clinical and Translational Science Award(CTSA)program,grant 2 UL1 TR000442-06 

主　　题：Lung transplant Heart transplant Organ size Size mismatch Organ allocation 

摘      要：Donor-to-recipient organ size matching is a critical aspect of thoracic transplantation. In the United States potential recipients for lung transplant and heart transplant are listed with limitations on donor height and weight ranges, respectively. Height is used as a surrogate for lung size and weight is used as a surrogate for heart size. While these measures are important predictors of organ size, they are crude surrogates that fail to incorporate the influence of sex on organ size. Independent of other measures, a man s thoracic organs are approximately 20% larger than a woman s. Lung size can be better estimated using the predicted total lung capacity, which is derived from regression equations correcting for height, sex and age. Similarly, heart size can be better estimated using the predicted heart mass, which adjusts for sex, age, height, and weight. These refined organ sizing measures perform better than current sizing practice for the prediction of outcomes after transplantation, and largely explain the outcome differences observed after sex-mismatch transplantation. An undersized allograft is associated with worse outcomes. In this review we examine current data pertaining to size-matching in thoracic transplantation. We advocate for a change in the thoracic allocation mechanism from a height-or-weightbased strategy to a size-matching process that utilizes refined estimates of organ size. We believe that a size-matching approach based on refined estimates of organ size would optimize outcomes in thoracic transplantation without restricting or precluding patients from thoracic transplantation.