Size matching in lung transplantation.

Volume concordance between donor lungs and the chest cavities of transplant recipients has important perioperative and postoperative implications. Between December 1987 and August 1991, 90 patients underwent lung transplantation in the Joint Marseilles-Montreal Lung Transplantation Program: 51 patients had double lung transplants, 19 patients had single lung transplants, and 20 patients had heart-lung transplants. There were 18 children (age range, 7 to 17 years) and 72 adults (age range, 18 to 58 years). Size matching was based on measurement of the submammary thoracic perimeter. Patient age (+/- 2 years) was also taken into consideration in children. Airway anastomoses were bronchial except for all heart-lung transplant patients and two double lung transplant patients, who had tracheal anastomoses. Occasional differences between donor and receiver bronchial diameters in children (greater donor size twice and smaller donor size once) required bronchoplasty in three instances. Healing was normal in these three instances, and no bronchial stenoses were noted. Performance of separate sutures rather than continuous running sutures on the cartilaginous anterior portion facilitated correction of airway diameter inequalities in adults. Excess volume was noted in three patients during closure of the thorax. In one patient, donor and recipient thoracic perimeters were similar. In two patients, however, donor size was greater by more than 20%. This was corrected by pneumoreduction with a surgical stapler. Lung size was decreased by 10% to 40% with use of this technique. Thoracic closure was facilitated and hemodynamic instability was thus corrected. No functional abnormalities were noted after surgery once the differences in lung size were corrected. In three cases, donor lung volume was smaller (15% in a child, and 20% in two adults) compared with that of the recipient. This was without consequence in two patients, but one patient died after an air leak that lasted 6 weeks. ID two double lung transplant patients, the hemithorax of the recipient was smaller because of preexisting illness. Reduction of donor lung size was not necessary. In summary, measurement of the submammary thoracic perimeter is sufficient to determine concordance of volumes between donor and recipient in most cases. Excess volume that hinders thoracic closure can be efficiently corrected by stapling. Bronchoplasty may be performed safely to correct differences of bronchial diameters in children.