Original Article
Austin J Pulm Respir Med 2014;1(3): 1014.
Characterization of Donor to Recipient Size Matching in Lung Transplantation
Hisham Taher1, Robert M Reed2 and Michael Eberlein1*
1Division of Pulmonary, University of Iowa Hospitals and Clinics, Iowa
2Division of Pulmonary and Critical Care Medicine, University of Maryland Scholl of Medicine, Maryland
*Corresponding author: Michael Eberlein, Lung Transplant Program, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, C 33 GH, Iowa City, IA 52242
Received: June 01, 2014; Accepted: July 28, 2014; Published: Aug 04, 2014
Abstract
Rationale: Donor to recipient lung size matching is an important aspect of lung transplantation (LTx). Height is an important predictor of lung size. However gender affects lung size independent of height. The predicted total lung capacity (pTLC), as an estimate of lung size, can be calculated from regression equations based on gender and height.
Objective: To characterize the donor-recipient lung size matching based on the pTLC ratio (= pTLC donor/pTLC recipient), height and gender.
Methods: All adult patients in the United Network for Organ Sharing (UNOS) transplant registry who underwent first-time LTx between October 1989 and April 2010 were studied, and the pTLC ratio was calculated. Subjects were then grouped into pTLC ratio strata (stratum 1: pTLC ratio<0.8 “very undersized”; stratum 2: pTLC ratio 0.8-1.0 “undersized”; stratum 3: pTLC ratio 1.0-1.2 “oversized” and stratum 4: pTLC ratio>1.2 “very oversized”).
Results: The pTLC ratio was available for 17,779 of the 19,812 study patients (89.7%). The mean pTLC ratio was 1.07 ± 0.21 (range 0.4 – 2.0). The mean pTLC ratio progressively decreased by transplant era from 1.14 in 1989 to 1.04 in 2010 (p <0.0001). Subjects in “size matched” strata 2 and 3 were 83% and 93% gender matched. In the very undersized stratum 1 87% of patients had a female donor to male recipient gender-mismatch, whereas in the very oversized stratum 4 80% of patients had a male donor to female recipient gender-mismatch. In the group of subjects with restrictive lung disease the percentage the very undersized stratum 1 increased from 5.9% in the 1989- 1994 eras to 16.4% in the 2006-2010 eras.
Conclusion: Donor-recipient lung size matching is best estimated by donor to recipient pTLC ratio, as the important effect of gender on lung size is accounted for in this metric. The evolution towards lower pTLC ratio’s (more under sizing) over time, especially for restrictive lung diseases, is contrary to the growing evidence showing the outcome benefits of oversized allograft.
Keywords: Lung transplantation; Lung size matching; predicted total lung capacity
Introduction
Donor to recipient lung size matching is an important aspect of lung transplantation (LTx) [1-4]. However it remains controversial what the best parameter for the size matching decision is and if parameters of donor-recipient lung size matching have a relationship to outcomes after LTx. The 27th -30thinternational society of heart and lung transplantation (ISHLT) registry report showed that donor to recipient height differences correlated with the risk of death at 1 year: the taller the donor in relation to the recipient, the lower the hazard ratio for one year mortality [5,6]. Worse survival after a female-donor to male recipient LTx has been reported in several studies [7,8]. In the United States potential recipients for lung transplantation are listed with acceptable donor height ranges [2]. Height is an important predictor of lung size [9]. However gender affects lung size independent of height [9]. The predicted total lung capacity (pTLC), as an estimate of lung size, can be calculated from regression equations based on gender and height [9]. Donor-recipient lung size matching can be estimated by donor to recipient pTLC ratio [3,4,10-18]. A study of bilateral lung transplant recipients from three transplant centers reported the association of a higher pTLC ratio, suggestive of oversized allograft with improved survival [16]. Furthermore an analysis of the Scientific Registry of Transplant Recipients (SRTR) database demonstrated an association between undersized allograft and increased mortality in the first year post-transplant [3]. The transplant indication can affect the lung size matching decision [1,3,12,16]. There is a general preference toward over sizing in chronic obstructive pulmonary disease (COPD) [1]. Whereas, for idiopathic pulmonary fibrosis (IPF) there is a general preference to undersize [1]. However in the SRTR database analysis there was no interaction between the pTLC ratio and lung disease diagnosis cluster (Lung allocation score groups A–D) on survival and the pTLC ratio was an independent predictor of 1 year mortality [3]. There was an interaction between the lung allocation score (a parameter of recipient acuity) and the pTLC ratio. The impact of pTLC ratio on 1 year mortality increased as the lung allocation score (i.e. acuity) increased [3].
The aim of this report is to characterize donor to recipient lung size matching based on the pTLC ratio, height, and gender and transplant indication using Organ Procurement and Transplantation Organization (OPTN) Standard Transplant Analysis and Research (STAR) files of the thoracic organ transplant registry.
Data Source
This study was approved by the Institutional Review Board at the Johns Hopkins Hospital and at the University of Iowa Hospitals and Clinics. STAR files with follow-up were provided by the OPTN. Data are compiled from individual centers and entered by trained data entry personnel using an electronic system with built-in data validation processes that cross-reference multiple sources. The data set comprises a prospectively collected open cohort of U.S. LTx patients (10/1989 through 4/2010) with follow-up through July 2010.
Study Design
This cohort study examined adult (aged ≥18 years) primary LTx patients from October 1989 to April 2010. Estimates of lung and thorax size were calculated from sex and height, as the predicted total lung capacity (pTLC) [9].
-pTLC for Male = 7.99 x [Height in meter] - 7.08.
-pTLC for Female= 6.60 x [Height in meter] - 5.79.
The size of donor lungs was compared to the size of a recipient’s thorax by calculating the ratio of the donor’s pTLC to the recipient’s pTLC (pTLC ratio) [3,4,10-18]. Patients with missing information to calculate the pTCL ratio were excluded. Patients with height recordings below 100 cm, or with pTLC ratios <0.4 or >2.0 were excluded, with the concern that these likely represented a data entry error. Based on clinical size matching considerations, patients were then grouped into pTLC ratio strata (stratum 1: pTLC ratio<0.8 “very undersized”; stratum 2: pTLC ratio 0.8-1.0 “undersized”; stratum 3: pTLC ratio 1.0-1.2 “oversized” and stratum 4: pTLC ratio>1.2 “very oversized”).
Statistical Analysis
Baseline characteristics were compared among pTLC ratio strata by one-way analysis of variance (continuous variables) and chi-square tests (categoric variables). For significant associations, pair-wise comparisons were performed by using the Tukey-Kramer method for continuous variables or by univariate logistic regression for categoric variables.
For all analyses, p<0.05 (2-tailed) was significant. Means are presented with standard deviations, medians with interquartile range (IQR), and hazard ratios (HR) with 95% confidence intervals (CI). Statistical analysis was performed using STATA 11 SE software (Stata Corp-LP, College Station, TX).
Results
Study population
From 1989 to 2010, 19,812 adult patients underwent first time LTx. The pTLC ratio was available for 17,779 patients (89.7%) and these constituted the study population. The mean pTLC ratio progressively decreased by transplant era from 1.14 in 1989 to 1.04 in 2010 (p <0.0001).Within diagnosis there was a decrease in the mean pTLC ratio by era in idiopathic pulmonary fibrosis (IPF), primary pulmonary hypertension (PPH) and “Other” indications, whereas the mean pTLC ratio of cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) patients did not change significantly, Figure 1.
Figure 1: Mean pTLC ratio according to transplant year stratified by transplant indication. Black lines represent the regression lines and grey shaded areas represent the 95% Confidence interval. The grey dotted line highlights pTLC ratio = 1 line.
Stratification according to pTLC ratio and clinical characteristics
The study population was analyzed according to pTLC ratio strata 1-4, as defined in the methods section Table1. The donor-recipient height, gender and pTLC relations for the pTLC ratio strata 1-4 are shown in Figure 2. Patients in strata2and 3 were 83% and 93% gender matched. In the very undersized stratum 1 87% of patients had a female donor to male recipient gender-mismatch, whereas in the very oversized stratum 4 80% of patients had a male donor to female recipient gender-mismatch. From stratum1 to 4 recipient pTLC progressively decreased from 6.88 liters to 5.01 liters, whereas donor pTLC progressively increased from 5.03 liters to 6.89 liters. The distribution of patients among pTLC ratio strata according to transplant era is shown in Figure 3. The percentage of patients in pTLC ratio stratum 1 increased from 6.1% in the 1989-1994 eras to 9.2% in the 2006-2010 era; whereas the percentage of patients in pTLC ratio stratum 4 patients decreased from 16.8% to 5.5%. The distribution of IPF patients among pTLC ratio strata according to transplant era is shown in Figure 4. The percentage of IPF patients in pTLC ratio stratum 1 increased from 5.9% in the 1989-1994 eras to 16.4% in the 2006-2010 era.
Figure 2: Recipient and donor characteristics according to pTLC ratio strata by A) Height matching B) Gender matching and C) pTLC ratio matching. Stratum 1: < 0.8 “very undersized”; stratum 2: 0.8 -1.0 “undersized”; stratum 3: 1.0 -1.2 “oversized” and stratum 4: > 1.2 “very oversized”.
Figure 3: Relative distribution of the entire cohort of LTx patients (n = 17779) into pTLC ratio strata 1-4 according to transplant era (1989-1994, 1995-200, 2001-2005, 2006-2010). Stratum 1: < 0.8 “very undersized”; stratum 2: 0.8 -1.0 “undersized”; stratum 3: 1.0 -1.2 “oversized” and stratum 4: > 1.2 “very oversized”.
Figure 4: Relative distribution of the cohort of Idiopathic Pulmonary Fibrosis LTx patients (n =4167) into pTLC ratio strata 1-4 according to transplant era (1989-1994, 1995-200, 2001-2005, 2006-2010). Stratum 1: < 0.8 “very undersized”; stratum 2: 0.8 -1.0 “undersized”; stratum 3: 1.0 -1.2 “oversized” and stratum 4: > 1.2 “very oversized”.
STRATUM 1
pTLC ratio< 0.8
(n = 1365)
STRATUM 2
pTLC ratio 0.8 -1.0
(n = 5586)
STRATUM 3
pTLC ratio1.0 -1.2
(n = 6993)
STRATUM 4pTLC ratio> 1.2
(n = 3814)
Parameter
Result
SD/%
Result
SD/%
Result
SD/%
Result
SD/%
pa
Size Matching
pTLC recipient
6.88b
0.83
6.44 b
1.14
6
1.12 b
5.01
0.62
<0.001
pTLC donor
5.03 b
0.65
5.96 b
1.11
6.5
1.18
6.89 b
0.79
<0.001
pTLC ratio
0.73 b
0.05
0.93 b
0.06
1.09 b
0.05
1.38
0.13
<0.001
Diff. in liter
-1.86 b
0.48
-0.5 b
0.38
0.5 b
0.32
1.87
0.6
<0.001
Gender Matching
match, count
164/1365 b
12%
4656/5607b
83%
6503/6993b
93%
763/3814
20%
<0.001
F to M, count
1188/1365b
87%
897/5607 b
16%
0/6993
0%
0/3814
0%
<0.001
M to F, count
13/1365
1%
54/5607
1%
490/6993
7%
3051/3814
80%
<0.001
Recipient factors
Age (years)
51.76 b
13.47
50.9 b
12.9
50.91 b
12.79
49.5
12.74
<0.001
BMI (kg/m2)
25.22 b
5.21
24.7 b
5.18
24.39 b
5.23
23.59
5.13
<0.001
Diabetes,count
218/1281b
17%
675//5189b
13%
840/6464b
13%
338/3384
10%
<0.001
Creatinine (mg/dl)
0.97 b
0.65
0.94 b
1
0.9
0.5
0.87
1.1
<0.001
Hemodynamics
PAS (cm H20)
44.87 b
21.15
43.3
19.8
41.88
19
42.3
19.93
<0.001
Cardiac output (l)
5.46 b
1.49
5.42 b
1.54
5.24 b
1.45
4.94
1.36
<0.001
PCW >15
249/1146
22%
1060/4655
23%
1339/5789
23%
650/3104
21%
0.1
Acuity
Hosp, count
95/1362
7%
335/5586
6%
419/6976
6%
228/3805
6%
0.09
ICU, count
109/1362 b
8%
335/5586
6%
279/6976
4%
190/3805
5%
<0.001
Vent, count
68/1365 b
5%
224/5607
4%
210/6993
3%
114/3814
3%
0.009
ECMO, count
13/1365 b
1%
56/5607
1%
28/6993
0.40%
16/3814
0.4%
0.01
LAS, median (IQR)c
43.22 b
18.66
40.1 b
14
37.15 b
10.87
35.7
8.62
<0.001
Indication
COPD, count
301/1365 b
22%
1921/5607b
34%
3147/6993b
45%
2011/3814
53%
<0.001
PPH, count
41/1365 b
3%
234/5607 b
4%
279/6993 b
4%
225/3814
6%
<0.001
CF, count
177/1365
13%
739/5607
13%
979/6993
14%
490/3814
13%
0.4
IPF, count
585/1365 b
43%
1638/5607b
30%
1469/6993b
21%
450/3814
12%
<0.001
Other, count
260/1365
19%
1075/5607b
19%
1119/6993
16%
638/3814
17%
<0.001
Donor factors
Age (years)
37.22 b
14.4
33.4 b
14.1
31.88 b
13.67
28.6
12.67
<0.001
pO2 (mmHg)
406.1
141.6
405
141
406.6
140.1
406
142.8
0.96
Ischemic time (h)
5.02 b
1.77
4.84 b
1.72
4.75 b
1.73
4.44 b
1.69
<0.001
Smoking, count
300/1306
23%
1172/5326
22%
1458/6626
22%
726/3455
21%
0.51
BMI (kg/m2)
25.3 b
5.88
24.8 b
4.94
24.6 b
4.84
24
4.44
<0.001
Transplant factor
Bilateral LTx
819/1365 b
60%
3196/5607b
57%
3706/6993b
53%
1831/3814
48%
<0.001
High center Vol.
983/1365 b
72%
3925/5607b
70%
4825/6993b
69%
2479/3814
65%
<0.001
LTx after yr. 2000
1010/1365b
74%
3981/5607b
71%
5105/6993b
73%
2403/3814
63%
<0.001
Table 1: Patient characteristics by pTLC ratio strata.
Discussion
This is a large registry study characterizing the donor to recipient lung size matching in lung transplantation based on the pTLC ratio (= pTLC donor / pTLC recipient), height and gender. Subjects in “size matched” groups were mostly gender matched. However, very undersized subjects mostly had a female donor to male recipient gender-mismatch, whereas oversized subjects mostly had a male donor to female recipient gender-mismatch. The mean pTLC ratio progressively decreased over time from, especially for restrictive lung diseases.
Time trend towards undersizing
The temporal evolution of the donor to recipient size matching over time is of interest. Over the 2 decade study period there was a decrease in mean pTLC ratios form 1.14 in 1989 to 1.04 in 2010 (p<0.0001). This decrease over time could be explained by the increased proportion of patients with restrictive lung disease transplanted with introduction of the lung allocation score (LAS) in 2005 [2]. However, within the diagnosis of IPF the percentage of patients in pTLC ratio stratum 1 (< 0.8) increased from 5.9% in the 1989-1994 era to 16.4% in the 2006-2010 era.
In general a recipient’s transplant indication affects the listing of acceptable donor lung sizes, as it is believed that the underlying diagnosis might persistently alter chest wall mechanics and thorax size [1]. Patients with restrictive lung disease are in general listed with a preference towards undersized donor lungs, whereas patients with obstructive lung disease are in general listed with a preference towards oversized donor lungs [1].
An analysis of the Scientific Registry of Transplant Recipients (SRTR) database demonstrated an association between undersized allograft and increased mortality in the first year post-transplant [3]. Furthermore the pTLC ratio was an independent predictor of 1 year mortality, even when adjusted for transplant indication [3]. Most importantly the impact of pTLC ratio on 1 year mortality increased as the lung allocation score increased [3]. In an ancillary study to the Lung Transplant Outcomes Group study, a pTLC ratio>1.0, suggestive of an oversized allograft, was associated with a decreased risk of grade 3 primary graft dysfunction (PGD) after bilateral lung transplantation (BLT) [19]. Similarly in a single center study of BLT patients reported the association between a pTLC ratio> 1.0 and a decreased risk for the occurrence of PGD3 [11]. The association between an undersized allograft and an increased PGD and mortality risk was reported in living lobar lung transplantation in pediatric patients [20,21]. These observations have important implications as subjects with restrictive lung disease often have higher acuity, higher lung allocation scores and experience significant waitlist mortality [2]. Furthermore IPF is a clinical risk factor for PGD. Thus extending the acceptable donor lung size range to more oversized allograft could increase the potential donor pool, especially for patients with restrictive lung disease.
Height, gender and predicted total lung capacity
In the United States potential recipients for lung transplantation are listed with acceptable donor height ranges [2]. Height is an important predictor of lung size [9]. However gender affects lung size independent of height [9]. The pTLC, as an estimate of lung size, can be calculated from regression equations based on gender and height [9]. Donor-recipient lung size matching is best estimated by donor to recipient pTLC ratio. For example, the pTLC of a 170 cm female is 5.4 liters. The pTLC of a 170cm male is 6.5 liters. The pTLC ratio of a 170 cm female donor and 170 cm male recipient is 0.83, whereas the pTLC ratio of a 170cm male donor and 170cm female recipient is 1.20 [16].
In this study subjects in “size matched” strata 2 and 3 were 83% and 93% gender matched. In the very undersized stratum 1 87% of patients had a female donor to male recipient gender-mismatch, whereas in the very oversized stratum 4 80% of patients had a male donor to female recipient gender-mismatch.
Worse survival after a female-donor to male recipient LTx has been reported in several studies [7,8]. Interestingly, when the gender effect on lung size is accounted for, donor to recipient gender is not independently associated with survival anymore [3,12,16,18,22].
In the setting of a donor to recipient gender mismatch a height based lung allocation mechanism can be disadvantageous. Let’s take the hypothetical example of a 65 year old man with end stage lung disease from idiopathic pulmonary fibrosis (IPF), who is listed for LTx. He is 170 cm tall (and has a pTLC of 6.54 liters). This candidate for example is listed for an acceptable donor height range from 147– 170 cm, Table 2. He could receive on organ offer from a 35 year old male donor, who is 170 cm (and has a pTLC of 6.54 liters). However this candidate would never receive an offer for lungs from a 32 year old female donor, who is 175 cm tall (and has a pTLC is 5.76 liters – which is a smaller pTLC than the 170 cm male donor, Table 2). Thus in a height based allocation system lung transplant candidates do not receive donor lung offers that by pTLC (and pTLC ratio) would be very appropriate to consider.
Listed subject with IPF
Donor listing
Offer A
Offer B
Offer C
Age
65 years
12-60 years
25 years
25 years
32 years
Gender
Male
Either
Female
Male
Female
Height (cm)
170
147 – 170
147
170
175
pTLC (liter)
6.54
3.98- 6.54
3.98
6.54
5.76
pTLC ratio
0.61
1.00
0.88
Table 2: Hypothetical donor offers for a subject with idiopathic pulmonary fibrosis (IPF) listed for lung transplantation.
Limitations
The pTLC ratio as a marker of allograft–thorax mismatch is imprecise. The pTLC is calculated via regression equations based on gender and height and is derived from population norms9. The pTLC of the donor is likely reflective of the allograft size. However, the pTLC of the recipient might not accurately reflect the thorax size of a patient with end-stage lung disease of different etiologies. Techniques such as opto-electronic plethysmography or computed tomographic volume try might provide a more precise measurement [23]. Furthermore the effect of age and ethnicity on lung size should be adjusted for by further refinements in the regression equations for pTLC [24,25].
Conclusion
Donor-recipient lung size matching is best estimated by donor to recipient pTLC ratio, as the important effect of gender on lung size is accounted for in this metric. The evolution towards lower pTLC ratio’s (more under sizing) over time, especially for restrictive lung diseases, is contrary to the growing evidence showing the outcome benefits of oversized allograft. It may be of benefit to incorporate the pTLC ratio in to the allocation process by listing recipients for acceptable donor pTLC ranges.
Acknowledgement
This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the author alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, organizations imply endorsement by the U. S. Government.
References
- Barnard JB, Davies O, Curry P, Catarino P, Dunning J, Jenkins D, et al. Size matching in lung transplantation: an evidence-based review. See comment in PubMed Commons below J Heart Lung Transplant. 2013; 32: 849-860.
- Eberlein M, Garrity ER, Orens JB. Lung allocation in the United States. See comment in PubMed Commons below Clin Chest Med. 2011; 32: 213-222.
- Eberlein M, Reed RM, Maidaa M, Bolukbas S, Arnaoutakis GJ, Orens JB, et al. Donor-recipient size matching and survival after lung transplantation. A cohort study. See comment in PubMed Commons below Ann Am Thorac Soc. 2013; 10: 418-425.
- Ouwens JP, van der Mark TW, van der Bij W, Geertsma A, de Boer WJ, Koëter GH. Size matching in lung transplantation using predicted total lung capacity. See comment in PubMed Commons below Eur Respir J. 2002; 20: 1419-1422.
- Christie JD, Edwards LB, Kucheryavaya AY, Aurora P, Dobbels F, Kirk R, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult lung and heart-lung transplant report--2010. J Heart Lung Transplant 2010; 29:1104-1118.
- Yusen RD, Christie JD, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report--2013; focus theme: age. J Heart Lung Transplant 2013; 32: 965-978
- International Society of Heart and Lung Transplantation Registry, Sato M, Gutierrez C, Kaneda H, Liu M, Waddell TK, Keshavjee S. The effect of gender combinations on outcome in human lung transplantation: the International Society of Heart and Lung Transplantation Registry experience. See comment in PubMed Commons below J Heart Lung Transplant. 2006; 25: 634-637.
- Thabut G, Mal H, Cerrina J, Dartevelle P, Dromer C, Velly JF, et al. Influence of donor characteristics on outcome after lung transplantation: a multicenter study. See comment in PubMed Commons below J Heart Lung Transplant. 2005; 24: 1347-1353.
- Stocks J, Quanjer PH. Reference values for residual volume, functional residual capacity and total lung capacity. ATS Workshop on Lung Volume Measurements. Official Statement of The European Respiratory Society. Eur Respir J 1995; 8: 492-506.
- Dezube R, Arnaoutakis GJ, Reed RM, Bolukbas S, Shah AS, Orens JB, et al. The effect of lung-size mismatch on mechanical ventilation tidal volumes after bilateral lung transplantation. See comment in PubMed Commons below Interact Cardiovasc Thorac Surg. 2013; 16: 275-281.
- Eberlein M, Arnaoutakis GJ, Yarmus L, Feller-Kopman D, Dezube R, Chahla MF, et al. The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation. See comment in PubMed Commons below J Heart Lung Transplant. 2012; 31: 492-500.
- Eberlein M, Diehl E, Bolukbas S, Merlo CA, Reed RM. An oversized allograft is associated with improved survival after lung transplantation for idiopathic pulmonary arterial hypertension. See comment in PubMed Commons below J Heart Lung Transplant. 2013; 32: 1172-1178.
- Eberlein M, Permutt S, Brown RH, Brooker A, Chahla MF, Bolukbas S, et al. Supranormal expiratory airflow after bilateral lung transplantation is associated with improved survival. See comment in PubMed Commons below Am J Respir Crit Care Med. 2011; 183: 79-87.
- Eberlein M, Permutt S, Chahla MF, Bolukbas S, Nathan SD, Shlobin OA, et al. Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome. See comment in PubMed Commons below Chest. 2012; 141: 451-460.
- Eberlein M, Reed RM, Bolukbas S, Parekh KR, Arnaoutakis GJ, Orens JB, et al. Lung size mismatch and survival after single and bilateral lung transplantation. See comment in PubMed Commons below Ann Thorac Surg. 2013; 96: 457-463.
- Eberlein M, Reed RM, Permutt S, Chahla MF, Bolukbas S, Nathan SD, et al. Parameters of donor-recipient size mismatch and survival after bilateral lung transplantation. See comment in PubMed Commons below J Heart Lung Transplant. 2012; 31: 1207-1213.
- Mason DP, Batizy LH, Wu J, Nowicki ER, Murthy SC, McNeill AM, et al. Matching donor to recipient in lung transplantation: How much does size matter? See comment in PubMed Commons below J Thorac Cardiovasc Surg. 2009; 137: 1234-1240.
- Reed RM, Eberlein M. Sizing strategies in heart and lung transplantation: you cannot manage what you do not measure. See comment in PubMed Commons below Future Cardiol. 2014; 10: 303-306.
- M Eberlein, RM Reed, S Bolukbas, JB Orens, RG Brower, CA Merlo, et al. Lung Size Mismatch and Primary Graft Dysfunction after Bilateral Lung Transplantation. The Journal of Heart and Lung Transplantation 2013; 32: S41
- Lillehei CW, Shamberger RC, Mayer JE Jr, Burke RP, Koka BV, Arnold J, et al. Size disparity in pediatric lung transplantation. See comment in PubMed Commons below J Pediatr Surg. 1994; 29: 1152-1155.
- Sweet SC. Pediatric living donor lobar lung transplantation. See comment in PubMed Commons below Pediatr Transplant. 2006; 10: 861-868.
- Eberlein M, Bolukbas S, Reed RM. eComment. Gender mismatching in lung transplantation: lung size mismatch is the issue! See comment in PubMed Commons below Interact Cardiovasc Thorac Surg. 2013; 16: 435-436.
- Chen F, Fujinaga T, Shoji T, Yamada T, Nakajima D, Sakamoto J, et al. Perioperative assessment of oversized lobar graft downsizing in living-donor lobar lung transplantation using three-dimensional computed tomographic volumetry. Transpl Int. 2010; 23: e41-44.
- Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. See comment in PubMed Commons below Eur Respir J. 2012; 40: 1324-1343.
- Quanjer PH, Stanojevic S, Stocks J, Cole TJ. Ethnically specific norms for ventilatory function. See comment in PubMed Commons below Int J Epidemiol. 2012; 41: 1490.
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