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Michael Eberlein, MD, PhD; Robert M. Reed, MD; Servet Bolukbas, MD, PhD, FCCP; Steven D. Nathan, MD, FCCP; Roy G. Brower, MD
Author and Funding Information

From the University of Iowa Carver College of Medicine (Dr Eberlein); the Johns Hopkins University School of Medicine (Dr Brower); the Department of Thoracic Surgery (Dr Bolukbas), Dr.-Horst-Schmidt-Klinik; the Advanced Lung Disease Program (Dr Nathan), Inova Fairfax Hospital; and the School of Medicine (Dr Reed), University of Maryland.

Correspondence to: Michael Eberlein, MD, PhD, Division of Pulmonary, Critical Care and Occupational Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, Iowa 52242; e-mail: michael-eberlein@uiowa.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(2):543. doi:10.1378/chest.12-1006
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To the Editor:

We thank Dr Mao and colleagues for their comments on our article in CHEST.1 Investigations on lung transplantation are often single-center studies with limited external validity; thus, including data from two study sites strengthened our investigation. An analysis by study site showed comparable results for allograft function, and introducing study site as a variable into the Cox proportional hazard models for the occurrence of bronchiolitis obliterans syndrome (BOS) showed no significant interaction between study site and BOS (P = .748 for univariate and P = .774 for multivariate model).

Information on transplant protocols and recipient characteristics by study site for the same cohorts as in this investigation has been published.2 The concern was raised that oversizing the allograft could be associated with an increase in early postoperative complications. We reported in a subsequent study that oversized allografts, as estimated by a predicted total lung capacity ratio >1.0, were not associated with an increase in complications after bilateral lung transplant.3 The latter investigation was limited to the post-lung-allocation-score era, and the undersized cohort had a significantly higher lung allocation score, was more likely to be in the ICU prior to transplant, and had a higher need for cardiopulmonary bypass during transplant.3 Thus, differences in the acuity and complexity of undersized compared with oversized patients might account for some of the observed differences. Lung trimming because of an oversized allograft was required in only one patient in the study reporting on the effects of lung size mismatch on complications3; however, we do not have comprehensive data on this for the entire cohort for this study, which we expressed in the discussion of study limitations.1

Providing criteria for donor recipient size matching is beyond the scope of this investigation. However, we do believe that a better understanding of the mechanisms linking parameters of expiratory airflow capacity early after lung transplantation to the risk of developing BOS holds the promise of uncovering modifiable factors influencing survival after lung transplantation.1-5

Eberlein M, Permutt S, Chahla MF, et al. Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome. Chest. 2012;141(2):451-460.
 
Eberlein M, Reed RM, Permutt S, et al. Parameters of donor-recipient size mismatch and survival after bilateral lung transplantation [published online ahead of print October 28, 2011]. J Heart Lung Transplant. doi:10.1016/j.healun.2011.07.015.
 
Eberlein M, Arnaoutakis GJ, Yarmus L, et al. The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation. J Heart Lung Transplant. 2012;31(5):492-500.
 
Suhling H, Dettmer S, Rademacher J, et al. Spirometric obstructive lung function pattern early after lung transplantation. Transplantation. 2012;93(2):230-235.
 
Eberlein M, Permutt S, Brown RH, et al. Supranormal expiratory airflow after bilateral lung transplantation is associated with improved survival. Am J Respir Crit Care Med. 2011;183(1):79-87.
 

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References

Eberlein M, Permutt S, Chahla MF, et al. Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome. Chest. 2012;141(2):451-460.
 
Eberlein M, Reed RM, Permutt S, et al. Parameters of donor-recipient size mismatch and survival after bilateral lung transplantation [published online ahead of print October 28, 2011]. J Heart Lung Transplant. doi:10.1016/j.healun.2011.07.015.
 
Eberlein M, Arnaoutakis GJ, Yarmus L, et al. The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation. J Heart Lung Transplant. 2012;31(5):492-500.
 
Suhling H, Dettmer S, Rademacher J, et al. Spirometric obstructive lung function pattern early after lung transplantation. Transplantation. 2012;93(2):230-235.
 
Eberlein M, Permutt S, Brown RH, et al. Supranormal expiratory airflow after bilateral lung transplantation is associated with improved survival. Am J Respir Crit Care Med. 2011;183(1):79-87.
 
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