{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:49:52Z","timestamp":1782902992289,"version":"3.54.5"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>\n                    Size matching is an important concern during lung allocation for lung transplantation (LTx). Although some mismatch is accepted\u2014often favoring larger grafts for patients with chronic obstructive pulmonary disease (COPD)\u2014the optimal strategy remains unclear. This study evaluated the impact of graft size mismatch on postoperative outcomes in COPD. We retrospectively reviewed 130 of 491 patients who underwent LTx at a single center between January 2013 and December 2023. Patients were classified into three groups based on donor-to-recipient predicted total lung capacity ratio: undersized (&amp;lt;0.9), size-matched (0.9\u20131.1), and oversized (\u22651.1). Donor and recipient characteristics were collected. Primary graft dysfunction (PGD) was the primary endpoint; overall survival was secondary. Of the 130 patients, 17 (13%) received undersized grafts, 67 (52%) size-matched grafts, and 46 (35%) oversized grafts. The undersized group had a lower incidence of PGD at 48 and 72\u00a0h than other groups (\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.01 and\n                    <jats:italic>p<\/jats:italic>\n                    = 0.02). Grade 3 PGD at 72\u00a0h was less frequent among groups (p = 0.03). Overall survival was higher in the undersized group (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.018 and\n                    <jats:italic>p<\/jats:italic>\n                    = 0.045). Oversized grafts may not be optimal for LTx in COPD. Undersized grafts appear to be a viable strategy.\n                  <\/jats:p>","DOI":"10.3389\/ti.2026.16246","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:26:58Z","timestamp":1782901618000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Undersized lung grafts in chronic obstructive pulmonary disease transplant recipients: risk factor or acceptable compromise?"],"prefix":"10.3389","volume":"39","author":[{"given":"Yujiro","family":"Kubo","sequence":"first","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Jos\u00e9","family":"Giron","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Rodr\u00edguez D\u00e1vila","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Alayza Avenda\u00f1o","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diletta","family":"Mongiello","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Cordero Iglesias","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Romero Rom\u00e1n","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Crowley","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Mariscal","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Manuel","family":"Naranjo G\u00f3mez","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria Mar\u00eda","family":"Novoa Valent\u00edn","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gomez-de-Antonio","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department Hospital Universitario Puerta de Hierro Majadahonda","place":["Madrid, Spain"]},{"name":"Surgery Department, School of Medicine, Universidad Aut\u00f3noma de Madrid, IDIPHISA","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.17352\/2640-7973.000014","article-title":"Size matching in lung transplantation: a 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