Lung Retransplantation for Chronic Rejection: A Single-Center Experience
Lung Retransplantation for Chronic Rejection: A Single-Center Experience
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DOI：
10.1016/j.athoracsur.2017.07.025
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发表时间：
2018-01-01
影响因子：
4.6
通讯作者：
Smith, Michael A.
中科院分区：
文献类型：
--
作者：
Roy, Sreeja Biswas;Panchanathan, Roshan;Smith, Michael A.
背景资料。慢性肺移植功能障碍(CLAD)是不可逆转的，仍然是肺移植(LTX)后长期存活的最大障碍。再次移植是治疗CLAD的唯一确定的选择。我们分析了我们将再次移植作为CLA治疗选择的单中心经验。自2010年3月1日至2016年5月31日，连续419例患者在我所接受了LTX，其中29例为包皮再植。我们分析了人口学特征、肺分配评分、手术类型、住院时间和围手术期结果。采用Kaplan-Meier生存曲线估计精算生存率。总体而言，419名患者中有29名(6.9%)接受了再次移植治疗。初次LTX至再次移植的中位时间为1,163天(304~3,971天)。接受再次移植的患者比初次移植的患者更年轻，肺分配得分更高。大多数LTX手术是双侧的(93%的再次移植，95%的初次LTX)。再次移植患者的体外循环、严重移植物功能障碍的体外膜氧合支持和出血再探查的发生率较高(分别为p=0.010、p=0.019和p=0.029)。再次移植组的1年和5年生存率与初次LTX组相似(89.2%和64.3%，分别为89.7%和58.2%；P=0.79)。再次肺移植是治疗LTX后包裹性肺损伤的一种可行的方法。在这项研究中，再次移植的患者比初次LTX患者更年轻，肺分配评分更高，更有可能需要体外循环和术后体外膜氧合支持。术后住院时间和中短期存活率与原发LTX患者相当。(C)2018年，由胸外科医生学会主办
Background. Chronic lung allograft dysfunction (CLAD) is nonreversible and remains the biggest obstacle to long-term survival after lung transplantation (LTx). Retransplantation is the sole definitive therapeutic option for CLAD. We analyzed our single-center experience with retransplantation as a treatment option for CLAD.Methods. From March 1, 2010, to May 31, 2016, 419 consecutive patients underwent LTx at our institution; 29 of these procedures were retransplantations for CLAD. We analyzed demographic characteristics, lung allocation score, operation type, length of stay, and perioperative outcomes. Actuarial survival was estimated using Kaplan-Meier survival curves.Results. In total, 29 of 419 patients (6.9%) underwent retransplantation for CLAD. Median time from primary LTx to retransplantation was 1,163 days (range: 304 to 3,971 days). Patients undergoing retransplantation were younger and had higher lung allocation scores than primary transplantation patients. Most LTx procedures were bilateral (93% of retransplantations, 95% of primary LTx). Rates of cardiopulmonary bypass, extracorporeal membrane oxygenation support for severe primary graft dysfunction, and re-exploration for bleeding were higher in retransplantation patients (p = 0.010, p = 0.019, and p = 0.029, respectively). One- and 5-year survival rates in the retransplantation group were similar to those of the primary LTx group (89.2% and 64.3% versus 89.7% and 58.2%, respectively; p = 0.79).Conclusions. Lung retransplantation is a viable treatment option for CLAD after LTx. In this study, retransplantation patients were younger, had higher lung allocation scores, and were more likely to require cardiopulmonary bypass and postoperative extracorporeal membrane oxygenation support than primary LTx patients. Postoperative length of stay and short- and midterm survival were comparable with those of primary LTx patients. (C) 2018 by The Society of Thoracic Surgeons