A new treatment strategy for advanced idiopathic interstitial pneumonia - Living-donor lobar lung transplantation
A new treatment strategy for advanced idiopathic interstitial pneumonia - Living-donor lobar lung transplantation
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DOI：
10.1378/chest.128.3.1364
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发表时间：
2005-09-01
期刊：
影响因子：
9.6
通讯作者：
Shimizu, N
中科院分区：
文献类型：
--
作者：
Date, H;Tanimoto, Y;Shimizu, N
背景资料：在等待尸体肺移植的患者中，特发性间质性肺炎（HP）患者的死亡率最高。尸体肺移植的禁忌症包括目前的高剂量全身性皮质类固醇治疗，因为它可能增加气道，并发症和各种类型的感染。研究目的：分析活体供体肺叶肺移植（LDLLT）对晚期HP患者的影响，包括接受高剂量全身性皮质类固醇治疗的患者。设计：回顾性分析。地点：冈山大学医院和冈山医学中心。患者：我们报告了前9名接受LDLLT的晚期HP患者（7名女性和2名男性;年龄范围，13至55岁;岁）。所有9例患者的预期寿命非常有限，8例患者依赖于全身皮质类固醇治疗，高达50 mWd的泼尼松。结果：18例支气管哮喘患者均无呼吸道并发症发生。有一个早期死亡（11%），由于严重的急性排斥反应。8例患者（89%）目前存活，随访期为10至48个月。他们的肺活量达到2.03 +/- 0.20 L（平均值+/- SEM），为第1年预测值的71.4%。所有18名捐赠者都恢复了以前的生活方式。切除的肺病理诊断为普通间质性肺炎（UIP）在6例和纤维化非特异性间质性肺炎（NSIP）在3 cases.Conclusions：这些早期随访数据支持的选择LDLLT在晚期HP患者，包括UIP和纤维化NSIP，否则很快就会死亡。目前大剂量全身性皮质类固醇治疗不是LDLLT的禁忌症。
Background: Among patients awaiting cadaveric lung transplantation, patients with idiopathic interstitial pneumonia (HP) have been demonstrated to have the highest mortality rate. Contraindications to cadaveric lung transplantation include current high-dose systemic corticosteroid therapy because it may, increase airway, complications and various types of infection.Study objectives: To analyze the effect of living-donor lobar lung transplantation (LDLLT) for patients with advanced HP including those receiving high-dose systemic corticosteroids.Design: Retrospective analysis.Setting: Okayama University Hospital and Okayama Medical Center.Patients: We report on the first nine patients (seven female and two male; age range, 13 to 55 ;years) with advanced HP receiving LDLLT. All nine patients had a very limited life expectancy, and eight patients were dependent on systemic corticosteroid therapy, as high as 50 mWd of prednisone. LDLLT was performed under cardiopulmonary bypass using two lower lobes donated by two healthy, relatives.Results: There were no airway complications in the 18 bronchial anastomoses. There was one early death (11%) due to severe acute rejection. Eight patients (89%) are currently alive with a follow-up period of 10 to 48 months. Their vital capacity reached 2.03 +/- 0.20 L (mean +/- SEM), 71.4% of predicted at I year. All 18 donors have returned to their previous lifestyles. Excised lungs were pathologically diagnosed as usual interstitial pneumonia (UIP) in six cases and fibrotic nonspecific interstitial pneumonia (NSIP) in three cases.Conclusions: These early follow-up data support the option of LDLLT in patients with advanced HP, including UIP and fibrotic NSIP, who would die soon otherwise. Current high-dose systemic corticosteroid therapy is not a contraindication in LDLLT.