Determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease
Determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease
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DOI：
10.1164/rccm.200708-1283oc
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发表时间：
2008-05-15
影响因子：
24.7
通讯作者：
Porcher, Raphael
中科院分区：
文献类型：
--
作者：
Thabut, Gabriel;Ravaud, Philippe;Porcher, Raphael
理由：虽然慢性阻塞性肺疾病是肺移植的第一个适应症，但该手术在生存方面的益处仍然存在争议。目标：评估慢性阻塞性肺疾病患者肺移植生存益处的决定因素。方法：利用来自器官共享联合网络数据库的 8,182 名患者的信息，我们开发了一种基于数值模拟的方法来估计肺移植的生存获益。 肺移植的生存效果。测量和主要结果：主要结果测量是从移植名单登记时起测量的移植和未移植的中位生存期之间的差异。双肺移植的生存获益高于单肺移植（平均差异，307 天 [95% 置信区间，217-523]）。通过双肺移植，44.6%的患者将获得1年或以上的生存期，29.4%的患者将获得或丧失1年以下的生存期，26%的患者将丧失1年或以上的生存期。移植存活效果的主要决定因素是收缩肺动脉压、FEV(1)、体重指数、运动能力、功能状态以及持续机械通气或吸氧的需要。例如，79% FEV(1) 低于预测值 16% 的患者通过双肺移植可延长 1 年或更长时间，而 FEV(1) 超过 25% 的患者只有 11%。 结论：我们确定了与肺移植生存获益相关的几个因素。在将这些结果转化为临床实践之前，需要对我们的模型进行外部验证。
Rationale: Although chronic obstructive pulmonary disease is the first indication for lung transplantation, the benefit of the procedure in terms of survival remains debated.Objectives: To estimate the determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease.Methods: Using information from the United Network for Organ Sharing database on 8,182 patients, we developed an approach based on numerical simulations to estimate the survival effect of lung transplantation.Measurements and Main Results: The main outcome measure was the difference between median survival with transplantation and that without transplantation measured from time of transplant list registration. Survival benefit was greater with double than with single lung transplantation (mean difference, 307 d [95% confidence interval, 217-523]). With double lung transplantation, 44.6% of patients would gain 1 year or more, 29.4% would gain or lose less than 1 year, and 26% would lose 1 year or more. Major determinants of the survival effect of transplantation were systolic pulmonary artery pressure, FEV(1), body mass index, exercise capacity, functional status, and the need for continuous mechanical ventilation or oxygen. For instance, 79% of patients with an FEV(1) less than 16% of the predicted value would gain 1 year or more with double lung transplantation as compared with only 11% of patients with an FEV(1) of more than 25%.Conclusions: We identified several factors associated with the survival benefit of lung transplantation. External validation of our models is required before translating these results into clinical practice.