Abstract
Some patients with pulmonary fibrosis (PF) can have severe and fixed chest wall retraction; others regain the shape of their original rib cage once the lungs are removed. These 2 possibilities determine the size of the lung graft to be allocated but are not predictable with classical respiratory tests or computed tomography (CT) scan. We first measured chest wall elastance (E(cw)) with esophageal pressure on the day of transplantation (group 1) and then during pretransplant medical check-up, and used for donor selection (group 2). Twenty patients in group 1 had low pretransplantation actual total lung capacity/predicted total lung capacity (pTLC) ratio that was not correlated with E(cw). The amount of transplanted lung TLC(transplanted)/pTLC was correlated to E(cw) (R(2) = 0.43, p = 0.003). Patient with higher E(cw) required lung resection and had more primary graft dysfunction. In group 2, 20 patients' E(cw) measurements allowed for increase in TLC(transplanted)/pTLC from 79 ± 20% to 93 ± 18%, p = 0.023 with only 2 lung resections. E(cw) can be measured before transplantation to optimize size mismatch and lung resection.