Graft Side-mismatching for Single-lung Transplantation Does Not Affect Outcomes: Role of the Pre-operative Quantitative Lung Perfusion Scan

doi:10.1016/j.healun.2007.12.005

The Journal of Heart and Lung Transplantation

Volume 27, Issue 3, March 2008, Pages 272-275

https://doi.org/10.1016/j.healun.2007.12.005 Get rights and content

Background

There are concerns about which lung to explant during single-lung transplantation (SLT). Traditionally, a quantitative lung perfusion scan (QLPS) is performed, and the better-perfused lung is retained. Occasionally, there is transplantation with graft “side-mismatching,” where the less-well-perfused lung is retained. We performed a retrospective study of patients undergoing SLT at our institution to evaluate the effects of side-mismatching (according to the QLPS) on graft performance and outcome.

Methods

We defined graft side-mismatching with a prospectively designed formula using baseline QLPS, and defined patients as either side-matched or side-mismatched. Data on mortality, requirement for cardiopulmonary bypass, relative graft perfusion, lung function and exercise capacity were obtained from institutional databases and patients’ files.

Results

In a cohort of 114 patients, we defined 97 as having received a side-matched SLT and 17 as having received a side-mismatched graft. After lung transplantation, forced expiratory volume in 1 second (FEV₁) and exercise capacity improved in both groups (p < 0.001). Patients with mismatched lungs had significantly higher relative graft perfusion post-operatively (p = 0.0012). There was no significant difference between the two groups (matched vs mismatched) in mortality, physiologic parameters and need for cardiopulmonary bypass.

Conclusions

There is no apparent risk to the patient when a side-mismatched lung graft is transplanted. We conclude that side-mismatched lung transplantation appears to be feasible when required.

Section snippets

Methods

The institutional review board gave permission for this study. Information was collated on all patients followed up after SLT at our institute since 1998. Data were acquired from case notes and institutional database systems holding relevant information. We extracted data on pre-operative and 6-month post-operative QLPS, systolic pulmonary artery pressure (sPAP), forced expiratory volume in 1 second (FEV₁), oxygen saturation, peak oxygen extraction during cycle ergometry (Vo₂peak) and 6-minute

Results

Of the 119 SLTs in our database, 114 were eligible for analysis (in 5 patients information on the pre-operative isotope scan was missing). We determined that 17 patients received side-mismatched lungs and 97 received side-matched lungs according to their pre-operative QLPS scan. Results are shown in Table 2.

Discussion

In this retrospective series of 114 single-lung transplants, we did not demonstrate any deleterious effect of side-mismatching (according to QLPS) on outcome at 6 months or overall mortality.

The observation of increased graft perfusion in the mismatched patients is of interest because previous studies showed that lower graft perfusion with QLPS predicts onset of chronic rejection.⁶ We suggest that this difference reflects the fact that side-mismatched patients retain a poorer quality native

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International guidelines for the selection of lung transplant candidatesThe International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society
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There are more references available in the full text version of this article.

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Citation Excerpt :
Traditionally, perfusion scintigraphy SLF is performed before surgery in an attempt to transplant the lung on the side with the worst function. However, in a retrospective analysis of 114 patients, there was no significant difference between those who received a transplant in the worse or better of two lungs.40 The most feared long-term complication after lung transplantation is the development of chronic rejection.
Ventilation-perfusion scintigraphy (VPS) depicts the two main physiological processes that are fundamental to oxygen-dependent life. The test has affirmed its critical place in the evaluation of patients with lung cancer preparing for lung resection. The results of the study can differentiate patients who are very likely to survive surgery and the subsequent pulmonary function loss from those who are not. This review presents validated and evolving testing techniques for this critical indication. VPS has long been an integral part of the preoperative evaluation of lung transplant candidates, guiding the single lung grafts to the side with the worst function. New applications are emerging in the rapidly developing surgical and interventional management of severe chronic obstructive lung diseases. Enhanced by the advancements in hybrid imaging and computer processing, the VPS examination continues to be reinvented and updated to keep pace with the needs of modern medicine.
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Clinical lung and heart/lung transplantationGraft Side-mismatching for Single-lung Transplantation Does Not Affect Outcomes: Role of the Pre-operative Quantitative Lung Perfusion Scan

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Heart Lung Transplant

J Heart Lung Transplant

Am J Cardiol

International guidelines for the selection of lung transplant candidatesThe International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society

J Heart Lung Transplant

Clinical lung and heart/lung transplantation
Graft Side-mismatching for Single-lung Transplantation Does Not Affect Outcomes: Role of the Pre-operative Quantitative Lung Perfusion Scan