Medical Consultant System for Improving Lung Transplantation Opportunities and Outcomes in Japan
Medical Consultant System for Improving Lung Transplantation Opportunities and Outcomes in Japan
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DOI：
10.1016/j.transproceed.2014.12.041
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发表时间：
2015-04-01
影响因子：
0.9
通讯作者：
Kondo, T.
中科院分区：
文献类型：
--
作者：
Hoshikawa, Y.;Okada, Y.;Kondo, T.
由于捐献器官的短缺在日本特别严重，自2002年以来，移植顾问医生和当地医生之间建立了一种独特的伙伴关系，以最大限度地提高器官利用率。自2011年以来，已有超过25名肺咨询医生注册，专门评估供体肺，并为供体提供重症呼吸护理建议。在这项研究中，我们回顾性地回顾了该系统对肺移植机会和结果的疗效。187名脑死亡肺供体候选人按时间顺序分为3个阶段：第一阶段（1998年5月至2006年11月）和第二阶段（2006年12月至2011年1月），分别在医疗顾问要求当地医生使用支气管镜对其进行积极支气管吸引之前和之后；第三阶段（2011年2月至2013年1月），在肺部顾问出现之后。分析肺利用率、第一次、第二次脑死亡检查及恢复前第三次评估时Pao(2)/FIo(2)比值及移植物存活率。肺利用率在II期和III期明显高于I期。在I期和II期，第三期评估时的Pao(2)/FIo(2)比值明显低于第一次或第二次脑死亡检查时的Pao(2)/FIo(2)比值，而在III期不随时间恶化。II期和III期的移植物存活率明显高于I期。由于原发性移植物功能障碍导致的移植物死亡在I期明显高于II期和III期。总之，该系统在提高肺移植机会和预后方面是有效的。
Because the shortage of donor organs is especially serious in Japan, since 2002 a unique partnership between transplant consultant physicians and local physicians has been developed to maximize the organ utilization rate. Since 2011, more than 25 lung consultant physicians have been registered to specifically assess donor lungs and provide advice on intensive respiratory care to donors. In this study, we retrospectively reviewed the efficacy of this system for lung transplantation opportunities and outcomes. One hundred eighty-seven brain-dead lung donor candidates were chronologically divided into 3 phases: I (May 1998-November 2006) and II (December 2006-January 2011), before and after medical consultants requested that local physicians administer aggressive bronchial suctioning using bronchoscopy, respectively; and phase III (February 2011-January 2013), after the emergence of lung consultants. The lung utilization rate, Pao(2)/FIo(2) ratio at the first and second brain death examinations and at the tertiary assessment before recovery, and graft survival were analyzed. The lung utilization rate was significantly higher in phases II and III than in phase I. In phases I and II, the Pao(2)/FIo(2) ratio at the tertiary assessment was significantly lower than that at the first or the second brain death examination, whereas it did not worsen with time in phase III. Graft survival was significantly better in phases II and III than in phase I. Graft death due to primary graft dysfunction was significantly more frequent in phase I than in phases II and III. In conclusion, this system is effective in improving lung transplantation opportunities and outcomes.