Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis
Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis
复制标题
DOI：
10.1111/j.1432-2277.2010.01071.x
复制
发表时间：
2010-09-01
影响因子：
3.1
通讯作者：
Behr, Juergen
中科院分区：
文献类型：
--
作者：
Neurohr, Claus;Huppmann, Patrick;Behr, Juergen
P>特发性肺纤维化 (IPF) 是肺移植 (LTX) 的常见指征，肺动脉高压 (PH) 对结果产生负面影响。最佳手术类型仍然是一个有争议的话题。本研究的目的是评估移植前 PH 对 IPF 患者的影响。单次 LTX（SLTX，n = 46）是标准手术类型。双 LTX（DLTX，n = 30）仅在相关 PH 或其他化脓性肺部疾病的情况下进行。移植前临床参数没有显着差异。 DLTX 受者的术前平均肺动脉压显着较高（22.7 +/- 0.8 mmHg 对比 35.9 +/- 1.8 mmHg，P < 0.001）。移植后，DLTX 患者的 6 分钟步行距离和 BEST-FEV1 显着较高（6-MWD：410 +/- 25 m 与 498 +/- 23 m，P = 0.02；BEST-FEV1：71.2 +/- 3.0 (% pred) 与 86.2 +/- 4.2 (% pred)，P = 0.004）。双 LTX 接受者表现出显着更好的 1 年生存率、总体生存率和闭塞性细支气管炎综合征 (BOS) 生存率 (P < 0.05)。 Cox 回归分析证实 SLTX 是死亡和 BOS 的重要预测因子。单一 LTX 可为 IPF 患者提供可接受的生存率。 Double LTX 为选定的接受者提供了显着的好处。我们的数据保证了对 SLTX 与 DLTX 进行进一步试验，对包括 PH 在内的潜在混杂因素进行分层。
P>Idiopathic pulmonary fibrosis (IPF) is a frequent indication for lung transplantation (LTX) with pulmonary hypertension (PH) negatively affecting outcome. The optimal procedure type remains a debated topic. The aim of this study was to evaluate the impact of pretransplant PH in IPF patients. Single LTX (SLTX, n = 46) was the standard procedure type. Double LTX (DLTX, n = 30) was only performed in cases of relevant PH or additional suppurative lung disease. There was no significant difference for pretransplant clinical parameters. Preoperative mean pulmonary arterial pressure was significantly higher in DLTX recipients (22.7 +/- 0.8 mmHg vs. 35.9 +/- 1.8 mmHg, P < 0.001). After transplantation, 6-min-walk distance and BEST-FEV1 were significantly higher for DLTX patients (6-MWD: 410 +/- 25 m vs. 498 +/- 23 m, P = 0.02; BEST-FEV1: 71.2 +/- 3.0 (% pred) vs. 86.2 +/- 4.2 (% pred), P = 0.004). Double LTX recipients demonstrated a significantly better 1-year-, overall- and Bronchiolitis obliterans Syndrome (BOS)-free survival (P < 0.05). Cox regression analysis confirmed SLTX to be a significant predictor for death and BOS. Single LTX offers acceptable survival rates for IPF patients. Double LTX provides a significant benefit in selected recipients. Our data warrant further trials of SLTX versus DLTX stratifying for potential confounders including PH.