SUCCESSFUL OUTCOME OF LUNG TRANSPLANTATION IS NOT COMPROMISED BY THE USE OF MARGINAL DONOR LUNGS
SUCCESSFUL OUTCOME OF LUNG TRANSPLANTATION IS NOT COMPROMISED BY THE USE OF MARGINAL DONOR LUNGS
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DOI：
10.1016/s0022-5223(95)70190-7
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发表时间：
1995-06-01
影响因子：
6
通讯作者：
PATTERSON, GA
中科院分区：
文献类型：
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作者：
SUNDARESAN, S;SEMENKOVICH, J;PATTERSON, GA
肺移植因缺乏合适的供体而受到限制。为了解决这一短缺问题，我们已经开始使用不符合我们之前所有严格的捐赠者标准的供体肺。在1991年6月至1994年3月连续进行的133例肺移植中，供者被认为是理想的供者，因为他们符合以下所有公认的供者标准(组I)：年龄<55岁，吸烟<20包年，动脉血氧分压>300 mm Hg(采用吸入氧分1.0，呼气末正压5 cm H2O)，胸部X线片阴性，无浸润性或外伤(挫伤或气胸)。37名供者未能满足其中一项标准，7名供者未能满足其中两项标准，在边缘组(II组)的44名供者中，获得了51项边缘状态标准，如下：年龄超过55岁，2人；吸烟史20年或以上，9人；胸部X线片不满意，34人；动脉血氧分压低于300毫米汞，6人。共进行了63例单肺移植(I组44例，II组19例)，而双侧序贯移植70例(I组45例，II组25例)。在II组中，24例中，至少有一个实际植入的肺包含挫伤或浸润性病变。对两组受者的评估显示，术后机械通气持续时间的中位数(I组和II组均为3天)、移植后即刻的肺泡-动脉血氧差(I组为304+/-14 mm Hg对II组为275+/-22 mm Hg；p=0.266)或24小时时(I组为125+/-12 mm Hg对II组为122+/-18 mm Hg；p=0.933)(所有数值代表平均正负标准差)均无显著差异。然而，边缘组(25例中有5例，20%)比I组(45例中6例，13%)更需要体外循环来促进双侧序贯移植中的二次移植物植入。I组30天内死亡3例(手术死亡率3.4%)，II组无一例死亡。目前I组89例中存活74例(83.2%)，II组34例中38例(86.4%)存活。
Lung transplantation is limited by a shortage of suitable donors. To address this shortage, we have begun using donor lungs that do not meet all of our previous rigorous donor criteria. Of 133 consecutive lung transplants done between June 1991 and March 1994, 89 donors were considered ideal because they satisfied all of the following accepted donor criteria (group I): age younger than 55 years, smoking less than 20 pack-years, arterial oxygen tension greater than 300 mm Hg (using inspired oxygen fraction of 1.0 and positive end-expiratory pressure 5 cm H2O), and chest radiograph negative for infiltrate or trauma (contusion or pneumothorax). Thirty-seven donors failed to satisfy one of these criteria and seven donors failed to satisfy two of them, yielding 51 criteria denoting marginal status in the 44 donors in the marginal group (group II) as follows: age older than 55 years, 2; smoking history 20 or more pack-years, 9; unsatisfactory chest radiograph, 34; and arterial oxygen tension less than 300 mm Hg, 6. Sixty-three single lung transplants were done (group I, 44 versus group II, 19) compared with 70 bilateral sequential transplants (group I, 45 versus group II, 25). In 24 cases in group II, at least one of the lungs actually being implanted contained contusion or infiltrate. Evaluation of recipients from the two groups showed no significant difference in median duration of postoperative mechanical ventilation (3 days in both group I and group II) nor in alveolar-arterial oxygen gradient immediately after transplantation (group I, 304 +/- 14 mm Hg versus group II, 275 +/- 22 mm Hg; p = 0.266) or at 24 hours (group I, 125 +/- 12 mm Hg versus group II, 122 +/- 18 mm Hg; p = 0.933) (all values represent mean plus or minus the standard error). However, cardiopulmonary bypass was required to facilitate second graft insertion in bilateral sequential transplants more often in the marginal group (5 of 25, 20%) than in group I (6 of 45, 13%). There were three deaths within 30 days in group I (operative mortality, 3.4%) and none in group II. Currently, 74 (83.2%) of 89 remain alive in group I compared with 38 (86.4%) of 34 in group II. On the basis of these data, we conclude that successful outcome of lung transplantation can be achieved with the use of marginal donor lungs.