Lobar lung transplantation from deceased donors: A systematic review

Table 1 Study characteristics

Author	Year	Country	Center	Time	Nr	Indication/diagnosis					Acuity
						CF	IPF	IPAH	COPD	Other
Couetil	1997	France	Paris	1993-1994	7	3	1	2	1	-	Not reported
Espinosa	2010	Spain	Reina Sofia	2003-2009	6	-	-	-	-	-	2 ICU,
											2 Hosp,
											2 Outpatient
Deuse	2011	Germany	Hamburg	2009-2012	71	2	5	-	-	-	1 ECMO
Marasco	2012	Australia	Alfred	1990-2012	271	6	5	-	4	12	Not reported
Inci	2012	Swiss	Zurich	2000-2012	23	10	8	-	3	2	3 ECMO, 1 MV,
Shigemura	2013	United States	UPMC	2010-2012	351	4	17	-	-	14	7 ECMO, 9 MV, LAS 72-94
Mitilian	2013	France	Foch	1988-2012	50	35	7	-	3	5	2 ECMO
Aigner	2014	Austria	Vienna	2001-2012	1381	48	46	8	16	20	27 MV, 18 ECMO
Stanzi	2014	Belgium	Leuven	2005-2012	8	8	-	-	-	-	All outpatients

¹Updated data provided. Nr: Number; CF: Cystic fibrosis; IPF: Idiopathic pulmonary fibrosis; IPAH: Idiopathic pulmonary arterial hypertension; OB: Obliterative bronchiolitis; COPD: Chronic obstructive pulmonary disease; ECMO: Extracorporeal membrane oxygenation; ICU: Intensive care unit; Hosp: Hospitalized; MV: Mechanical ventilation; LAS: Lung allocation score.

Table 2 Size matching parameters and characteristics

Center	Size matching parameter	pTLC donor (full)	pTLC donor (lobar)	pTLC recipient	pTLCratio (full)	pTLCratio (lobar)
Paris	pTLCratio	6.91 ± 0.7	3.11 ± 0.3	4.28 ± 1.1	1.69 ± 0.4	0.76 ± 0.5
Reina Sofia	Not reported	Not provided	Not provided	Not provided	Not provided	Not provided
Hamburg1	pTLCratio	6.96 ± 1.2	3.64 ± 0.7	5.27 ± 1.0	1.35 ± 0.3	0.69 ± 0.1
Alfred1	pTLCratio, CXR	6.82 ± 1.2	4.81 ± 1.1	5.12 ± 1.4	1.44 ± 0.5	0.94 ± 0.3
Zurich1	Visual inspection, height	7.21 ± 0.8	4.45 ± 0.7	5.04 ± 0.9	1.48 ± 0.4	0.90 ± 0.2
UPMC1	Height, CXR, visual inspection	6.28 ± 0.7	3.76 ± 0.7	5.22 ± 0.8	1.22 ± 0.9	0.73 ± 0.5
Foch	pTLCratio, visual inspection	Not provided	Not provided	Not provided	1.65	Not provided
Vienna1	pTLCratio, visual inspection	6.19 ± 1.1	3.80 ± 0.9	5.45 ± 1.0	1.15 ± 0.2	0.70 ± 0.1
Leuven1	Visual inspection, height	6.70 ± 1.2	4.11 ± 0.3	4.42 ± 0.4	1.52 ± 0.4	0.93 ± 0.3

¹Centers provided additional size matching data for this systematic review. pTLC: Predicted total lung capacity; CXR: Chest X-ray.

Table 3 Outcomes of deceased donor lobar lung transplantation compared to conventional lung transplant within the same center

Center	ComparisonGroup with CLTx (number, diagnosis)	PGD (grade)PostOP-ECMO	ICU LOS (d)	Hospital LOS(d)	Survival 1 year	Survival 5 years
Paris	No	Not reported	Not reported	Not reported	ddLLTx: 86%	Not reported
Reina Sofia	Yes (149 - mixed)1	Not reported	Not reported	Not reported	ddLLTx: 50%, CLTx: 72%1	Not reported
Hamburg	Yes (28 - mixed)4	Not reported	Not reported	Not reported	ddLLTx: 85%, CLTx: 72%4	Not reported
Alfred	Yes (329 - mixed)	ddLLTx: 56% ≥ PGD (2)	LLT: 12; CLTx: 4	ddLLTx: 30 CLTx: 21	ddLLTx: 81%, CLTx: 84% (P = 0.115)	ddLLTx: 52%5, CLTx: 37.5%5 (P = 0.115)
Zurich	Yes (219 - mixed)	ddLLTx: 13% PGD (not spec.)	Not reported	Not reported	ddLLTx: 82%; CLTx: 88% (P = 0.56)	ddLLTx: 64%; CLTx: 69% (P = 0.56)
UPMC	Yes (691 - mixed)2, Yes (65 - high LAS)3	ddLLTx: 36% ECMO	Not reported	Not reported	ddLLTx: 76%; CLTx: 83%1; (high LAS): 72%2	Not reported
Foch	Yes (445 - mixed)	ddLLTx: 54% ≥ PGD (1) 20% ECMO	ddLLTx: 17	ddLLTx: 43	ddLLTx: 60%, CLTx: 78% (NS)	ddLLTx: 46%, CLTx: 51% (NS)
Vienna	Yes (778 - mixed)	ddLLTx: 44% ≥ PGD1 32% ECMO	ddLLTx: 17; CLTx: 6	ddLLTx: 33.5 CLTx: 22	ddLLTx: 65.1; CLTx: 84.8% (P < 0.001)	ddLLTx: 54.9% CLTx: 69.9% (P < 0.001)
Leuven	Yes (66 - all CF)	ddLLTx: 25% PGD (3) at 48 h vs CLTx: 9%	ddLLTx: 12 CLTx: 5	ddLLTx: 37 CLTx: 24	ddLLTx: 100%; CLTx: 88.4% (NS)	Not reported

¹From contemporary, but separate reports from same transplant center as the ddLLTx group;

²From contemporary, but separate reports from same transplant center as the ddLLTx group;

³From contemporary, but separate reports from same transplant center as the ddLLTx group;

⁴Provided by center;

⁵Estimated from Kaplan Meier survival curve. PGD: Primary graft dysfunction; ECMO: Extracorporeal membrane oxygenation; ICU: Intensive care unit; LOS: Length of stay; NS: Not statistically significantly different; ddLLTx: Donor lobar lung transplantation; CLTx: Compared to conventional lung transplant.

Table 4 Post-transplant FEV1 outcomes of deceased donor lobar Lung transplantation

Center (Nr of ddLLTx)	Comparison group (Nr)	FEV1 (%) 3-6 mo	Peak FEV1 (%)	Correlation to pTLCratio
Paris (7)	No	6 mo: 62%	81%	Not reported
Reina Sofia (6)	No	Not reported	Not reported	Not reported
Hamburg (3)	No	Not reported	Not reported	Not reported
Alfred (23)	No	6 mo: 52.6%	Not reported	Yes FEV1(%) at 3 mo correlates with pTLCratioLobar (r = 0.549, P = 0.028)
Zurich (23)	No	6 mo: 75.3%	76.80%	Yes FEV1(%) at 3 mo correlates with pTLCratioLobar (r = 0.485, P = 0.04)
UPMC (25)	No	Not reported	85.20%	Not reported
Foch (50)	No	6 mo: 61.1%	67.30%
Vienna	No	Not reported	Not reported	Not reported
Leuven (6)	Yes CLTx (66)	3 mo: ddLLTx: 64.5% CLTx: 76%	ddLLTx: 80.5 CLTx: 99%	Not reported

ddLLTx: Donor lobar Lung transplantation; CLTx: Compared to conventional lung transplant.