Pulmonary retransplantation:: Predictors of graft function and survival in 230 patients
Pulmonary retransplantation:: Predictors of graft function and survival in 230 patients
复制标题
DOI：
10.1016/s0003-4975(97)01191-0
复制
发表时间：
1998-01-01
影响因子：
4.6
通讯作者：
Yacoub, MH
中科院分区：
文献类型：
--
作者：
Novick, RJ;Stitt, LW;Yacoub, MH
背景尽管肺移植的结果有所改善，但仍有相当数量的移植物在术后早期或晚期失败。肺再次移植登记处成立于1991年，旨在确定再次移植后结局的预测因素。我们假设受体的非卧床状态和中心再移植体积（先前已被证明可预测再移植后的存活率）也与术后移植物功能改善相关。从1985年到1996年，在47个中心有230例患者接受了再次移植。采用逻辑回归方法确定与再移植后存活率和肺功能相关的变量和预测变量。Kaplan-Meier生存率分别为47% ± 3%、40% ± 3%和33% ± 4%。在多变量分析中，生存预测因素包括术前非卧床状态或缺乏呼吸机支持（p = 0.005;比值比，1.62; 95%可信区间，1.15 - 2.27），其次是1991年后再次移植（p = 0.048;比值比，1.41; 95%可信区间，1.003 - 1.99）。1991年后接受再次移植的非卧床、非通气患者的1年生存率为64% ± 5%，而非卧床、通气患者的1年生存率为33% ± 4%。再次移植后1年、2年、3年和4年，分别有81%、70%、62%和56%的存活者未发生闭塞性细支气管炎综合征。与再次移植后2年无3期（重度）闭塞性细支气管炎综合征相关的因素包括两次移植的间隔时间超过2年（p = 0.01），再次移植前缺乏辅助支持（p = 0.03），每个中心内的再次移植经验增加（第5次及以上再次移植患者，p = 0.04），以及5次或以上再次移植手术的中心总容量（P = 0.05）。不能走动的，通气的患者不应考虑再次移植与其他候选人相同的优先权。最好的中期功能结果出现在经验更丰富的中心，非通气患者，以及首次移植后2年以上再次移植的患者。鉴于肺供体的稀缺性，再次移植的患者选择应保持严格，并应以本文回顾的结果数据为指导。(C)1998年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. Despite improving results in lung transplantation, a significant number of grafts fail early or late postoperatively. The pulmonary retransplant registry was founded in 1991 to determine the predictors of outcome after retransplantation. We hypothesized that ambulatory status of the recipient and center retransplant volume, which had been previously shown to predict survival after retransplantation, would also be associated with improved graft function postoperatively.Methods. Two hundred thirty patients underwent retransplantation in 47 centers from 1985 to 1996. Logistic regression methods were used to determine variables associated with, and predictive of, survival and lung function after retransplantation.Results. Kaplan-Meier survival was 47% +/- 3%, 40% +/- 3%, and 33% +/- 4% at 1, 2, and 3 years, respectively. On multivariable analysis, the predictors of survival included ambulatory status or lack of ventilator support preoperatively (p = 0.005; odds ratio, 1.62; 95% confidence interval, 1.15 to 2.27), followed by retransplantation after 1991 (p = 0.048; odds ratio, 1.41; 95% confidence interval, 1.003 to 1.99). Ambulatory, nonventilated patients undergoing retransplantation after 1991 had a 1-year survival of 64% +/- 5% versus 33% +/- 4% for nonambulatory, ventilated recipients. Eighty-one percent, 70%, 62%, and 56% of survivors were free of bronchiolitis obliterans syndrome at 1, 2, 3, and 4 years after retransplantation, respectively. Factors associated with freedom from stage 3 (severe) bronchiolitis obliterans syndrome at 2 years after retransplantation included an interval between transplants greater than 2 years (p = 0.01), the lack of ventilatory support before retransplantation (p = 0.03), increasing retransplant experience within each center (fifth and higher retransplant patient, p = 0.04), and total center volume of five or more retransplant operations (P = 0.05).Conclusions. Nonambulatory, ventilated patients should not be considered for retransplantation with the same priority as other candidates. The best intermediate-term functional results occurred in more experienced centers, in nonventilated patients, and in patients undergoing retransplantation more than 2 years after their first transplant. In view of the scarcity of lung donors, patient selection for retransplantation should remain strict and should be guided by the outcome data reviewed in this article. (C) 1998 by The Society of Thoracic Surgeons.