Impact of CLAD Phenotype on Survival After Lung Retransplantation: A Multicenter Study.
Impact of CLAD Phenotype on Survival After Lung Retransplantation: A Multicenter Study.
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外表型对肺部再生后生存的影响：一项多中心研究。
DOI：
10.1111/ajt.13281
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发表时间：
2015-08
期刊：
影响因子：
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通讯作者：
Haverich A
中科院分区：
文献类型：
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作者：
Verleden SE;Todd JL;Sato M;Palmer SM;Martinu T;Pavlisko EN;Vos R;Neyrinck A;Van Raemdonck D;Saito T;Oishi H;Keshavjee S;Greer M;Warnecke G;Gottlieb J;Haverich A
慢性同种异体肺功能障碍（CLAD）仍然是肺移植后的主要问题，除了在选定的候选人中进行再次肺移植（re-LTx）外，没有明确的治疗方法。然而，CLAD不是一个同质实体，存在不同的表型。因此，我们旨在评估CLAD表型对CLAD再LTx后生存率的影响。本回顾性分析纳入了2003年至2013年期间在4家LTx中心因继发于CLAD的呼吸衰竭接受再次LTx的患者。通过肺功能、放射学和植块肺组织病理学来区分闭塞性细支气管炎综合征（BOS）和限制性CLAD（rCLAD）。收集并分析重新LTx前后的患者变量。共有143例患者接受了CLAD的re-LTx，导致94例BOS（66%）和49例rCLAD（34%）患者。与BOS相比，rCLAD的re-LTx后的未校正和校正生存率更差（分别为HR=2.60，1.59-4.24; p<0.0001和HR=2.61，1.51-4.51; p=0.0006）。与住院患者相比，在重新LTx之前在家等待的患者的生存率更高（HR 0.40; 0.23-0.72; p=0.0022）。rCLAD患者更早再次发生CLAD，并且更有可能再次发生rCLAD。与BOS相比，rCLAD的再LTx后生存率更差。因此，应严格讨论rCLAD的re-LTx，特别是当存在其他围手术期风险因素时。
Chronic Lung Allograft Dysfunction (CLAD) remains a major problem after lung transplantation with no definitive treatment except redo lung transplantation (re-LTx) in selected candidates. However, CLAD is not a homogeneous entity and different phenotypes exist. Therefore, we aimed to evaluate the effect of CLAD phenotypes on survival after re-LTx for CLAD. Patients who underwent re-LTx for respiratory failure secondary to CLAD in 4 LTx centers between 2003 and 2013 were included in this retrospective analysis. Bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (rCLAD) were distinguished using pulmonary function, radiology and explant lung histopathology. Patient variables pre and post re-LTx were collected and analyzed. A total of 143 patients underwent re-LTx for CLAD resulting in 94 BOS (66%) and 49 rCLAD (34%) patients. Unadjusted and adjusted survival after re-LTx for rCLAD was worse compared to BOS (HR=2.60, 1.59–4.24; p<0.0001 and HR=2.61, 1.51–4.51; p=0.0006 respectively). Patients waiting at home prior to re-LTx experienced better survival compared to hospitalized patients (HR 0.40; 0.23–0.72; p=0.0022). Patients with rCLAD re-developed CLAD earlier and were more likely to re-develop rCLAD. Survival after re-LTx for rCLAD is worse compared to BOS. Consequently, re-LTx for rCLAD should be critically discussed, particularly when additional peri-operative risk factors are present.