Size Mismatching Increases Mortality After Lung Transplantation in Preadolescent Patients

Charles D. Fraser, Xun Zhou, Joshua C. Grimm, Alejandro Suarez-Pierre, Todd C. Crawford, Cecillia Lui, Errol Bush, Narutoshi Hibino, Marshall L Jacobs, Luca Vricella, Christian Merlo

Research output: Contribution to journalArticle

Abstract

Background: The effect of size mismatch between donor and recipient in pediatric lung transplantation (PLTx) is currently unknown. Previous studies in adults have suggested that oversized allografts are associated with improved outcomes after lung transplantation. We investigated this relationship to quantify its effect on posttransplant outcomes in children. Methods: The United Network of Organ Sharing database was queried for preadolescent (age <13 years) patients undergoing PLTx. Donor-to-recipient height, weight, and predictive total lung capacity (pTLC; ages 4 to 13; pTLC = 0.160 x exp[0.021 x height]) ratios were calculated. Exploratory analysis was performed to identify disjoint intervals at which survival was statistically different. Patients were categorized as well-matched, undersized, or oversized. Multivariate Cox proportional hazard regression modeling assessed the adjusted effect of mismatching on mortality. Survival analysis was performed using the Kaplan-Meier method. Results: The analysis included 540 children. One-year mortality was higher with a height mismatch of 5% or less (hazard ratio [HR], 2.97; p = 0.001) and above 5% (HR, 2.22; p = 0.009). Similarly, 1-year mortality was worse with weight mismatch of 10% or less (HR, 1.99; p = 0.035) and above 10% (HR, 2.04; p = 0.028). On unadjusted analysis, a pTLC ratio of less than 0.9 was associated with worse survival (p = 0.017). This finding persisted after multivariate risk adjustment (HR, 2.93; p = 0.02). Contrary to findings in adults, an oversized allograft (pTLC ratio > 1.1) was not associated with improved survival (HR, 1.95; p = 0.147). Conclusions: In preadolescent children undergoing PLTx, size mismatching is associated with increased death. Our findings differ from studies in adults, which demonstrated improved survival associated with oversized allografts. Accordingly, well-matched allografts should be prioritized when assessing donor-recipient pairs for transplantation.

Original languageEnglish (US)
Pages (from-to)130-137
Number of pages8
JournalAnnals of Thoracic Surgery
Volume108
Issue number1
DOIs
StatePublished - Jul 1 2019

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Lung Transplantation
Allografts
Mortality
Tissue Donors
Survival
Transplantation
Databases
Pediatrics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Size Mismatching Increases Mortality After Lung Transplantation in Preadolescent Patients. / Fraser, Charles D.; Zhou, Xun; Grimm, Joshua C.; Suarez-Pierre, Alejandro; Crawford, Todd C.; Lui, Cecillia; Bush, Errol; Hibino, Narutoshi; Jacobs, Marshall L; Vricella, Luca; Merlo, Christian.

In: Annals of Thoracic Surgery, Vol. 108, No. 1, 01.07.2019, p. 130-137.

Research output: Contribution to journalArticle

Fraser, Charles D. ; Zhou, Xun ; Grimm, Joshua C. ; Suarez-Pierre, Alejandro ; Crawford, Todd C. ; Lui, Cecillia ; Bush, Errol ; Hibino, Narutoshi ; Jacobs, Marshall L ; Vricella, Luca ; Merlo, Christian. / Size Mismatching Increases Mortality After Lung Transplantation in Preadolescent Patients. In: Annals of Thoracic Surgery. 2019 ; Vol. 108, No. 1. pp. 130-137.
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author = "Fraser, {Charles D.} and Xun Zhou and Grimm, {Joshua C.} and Alejandro Suarez-Pierre and Crawford, {Todd C.} and Cecillia Lui and Errol Bush and Narutoshi Hibino and Jacobs, {Marshall L} and Luca Vricella and Christian Merlo",
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T1 - Size Mismatching Increases Mortality After Lung Transplantation in Preadolescent Patients

AU - Fraser, Charles D.

AU - Zhou, Xun

AU - Grimm, Joshua C.

AU - Suarez-Pierre, Alejandro

AU - Crawford, Todd C.

AU - Lui, Cecillia

AU - Bush, Errol

AU - Hibino, Narutoshi

AU - Jacobs, Marshall L

AU - Vricella, Luca

AU - Merlo, Christian

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: The effect of size mismatch between donor and recipient in pediatric lung transplantation (PLTx) is currently unknown. Previous studies in adults have suggested that oversized allografts are associated with improved outcomes after lung transplantation. We investigated this relationship to quantify its effect on posttransplant outcomes in children. Methods: The United Network of Organ Sharing database was queried for preadolescent (age <13 years) patients undergoing PLTx. Donor-to-recipient height, weight, and predictive total lung capacity (pTLC; ages 4 to 13; pTLC = 0.160 x exp[0.021 x height]) ratios were calculated. Exploratory analysis was performed to identify disjoint intervals at which survival was statistically different. Patients were categorized as well-matched, undersized, or oversized. Multivariate Cox proportional hazard regression modeling assessed the adjusted effect of mismatching on mortality. Survival analysis was performed using the Kaplan-Meier method. Results: The analysis included 540 children. One-year mortality was higher with a height mismatch of 5% or less (hazard ratio [HR], 2.97; p = 0.001) and above 5% (HR, 2.22; p = 0.009). Similarly, 1-year mortality was worse with weight mismatch of 10% or less (HR, 1.99; p = 0.035) and above 10% (HR, 2.04; p = 0.028). On unadjusted analysis, a pTLC ratio of less than 0.9 was associated with worse survival (p = 0.017). This finding persisted after multivariate risk adjustment (HR, 2.93; p = 0.02). Contrary to findings in adults, an oversized allograft (pTLC ratio > 1.1) was not associated with improved survival (HR, 1.95; p = 0.147). Conclusions: In preadolescent children undergoing PLTx, size mismatching is associated with increased death. Our findings differ from studies in adults, which demonstrated improved survival associated with oversized allografts. Accordingly, well-matched allografts should be prioritized when assessing donor-recipient pairs for transplantation.

AB - Background: The effect of size mismatch between donor and recipient in pediatric lung transplantation (PLTx) is currently unknown. Previous studies in adults have suggested that oversized allografts are associated with improved outcomes after lung transplantation. We investigated this relationship to quantify its effect on posttransplant outcomes in children. Methods: The United Network of Organ Sharing database was queried for preadolescent (age <13 years) patients undergoing PLTx. Donor-to-recipient height, weight, and predictive total lung capacity (pTLC; ages 4 to 13; pTLC = 0.160 x exp[0.021 x height]) ratios were calculated. Exploratory analysis was performed to identify disjoint intervals at which survival was statistically different. Patients were categorized as well-matched, undersized, or oversized. Multivariate Cox proportional hazard regression modeling assessed the adjusted effect of mismatching on mortality. Survival analysis was performed using the Kaplan-Meier method. Results: The analysis included 540 children. One-year mortality was higher with a height mismatch of 5% or less (hazard ratio [HR], 2.97; p = 0.001) and above 5% (HR, 2.22; p = 0.009). Similarly, 1-year mortality was worse with weight mismatch of 10% or less (HR, 1.99; p = 0.035) and above 10% (HR, 2.04; p = 0.028). On unadjusted analysis, a pTLC ratio of less than 0.9 was associated with worse survival (p = 0.017). This finding persisted after multivariate risk adjustment (HR, 2.93; p = 0.02). Contrary to findings in adults, an oversized allograft (pTLC ratio > 1.1) was not associated with improved survival (HR, 1.95; p = 0.147). Conclusions: In preadolescent children undergoing PLTx, size mismatching is associated with increased death. Our findings differ from studies in adults, which demonstrated improved survival associated with oversized allografts. Accordingly, well-matched allografts should be prioritized when assessing donor-recipient pairs for transplantation.

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