Prognostic Factors in Lung Transplantation After Hematopoietic Stem Cell Transplantation
Prognostic Factors in Lung Transplantation After Hematopoietic Stem Cell Transplantation
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DOI：
10.1097/tp.0000000000001886
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发表时间：
2018-01-01
期刊：
影响因子：
6.2
通讯作者：
Date, Hiroshi
中科院分区：
文献类型：
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作者：
Chen-Yoshikawa, Toyofumi F.;Sugimoto, Seiichiro;Date, Hiroshi
背景。肺移植是造血干细胞移植（HSCT）后肺部并发症患者最后的救命选择。接受造血干细胞移植治疗的血液病患者被认为是肺移植的高危候选者；因此，很少对这些患者进行肺移植，也很少有研究报道。本研究旨在描述HSCT后肺部并发症患者肺移植的特点和结果。方法。我们回顾性调查了62例HSCT后接受肺移植的患者。所有数据均来自日本的6个肺移植中心。结果。17例患者行尸肺移植，45例行活体供体大叶肺移植（LDLLT）。在LDLLT组中，18名患者在HSCT后接受了LDLLT，其中一名供体也曾作为HSCT的供体。7例患者接受了单次LDLLT，供体与获得HSCT干细胞的患者相同。术前高碳酸血症52例（84%）。13例（21%）患者术前需要机械通气。55例患者因血液系统恶性肿瘤接受了造血干细胞移植，其中4例（7%）在肺移植后复发。5年生存率为64.2%。在一项多变量分析中，年龄小于45岁的患者和采用相同供体的患者的生存率明显提高（P分别为0.012和0.041）。结论。肺移植治疗HSCT后的肺部并发症是安全的，生存率更高，特别是在肺移植和HSCT涉及同一供体的年轻受者中。
Background. Lung transplantation is the final lifesaving option for patients with pulmonary complications after hematopoietic stem cell transplantation (HSCT). Patients undergoing HSCT for hematologic diseases are thought to be high-risk candidates for lung transplantation; therefore, few lung transplants are performed for these patients, and few studies have been reported. This study aimed to describe the characteristics and outcomes of lung transplantation in patients with pulmonary complications after HSCT. Methods. We retrospectively investigated 62 patients who underwent lung transplantation after HSCT. All data were collected from 6 lung transplant centers in Japan. Results. Seventeen patients underwent cadaveric lung transplantation, whereas 45 underwent living-donor lobar lung transplantation (LDLLT). In the LDLLT group, 18 patients underwent LDLLT after HSCT in which one of the donors had also served as a donor for HSCT. Seven patients underwent single LDLLT for which the donor was the same as the patient from whom stem cells were obtained for HSCT. Preoperative hypercapnia was observed in 52 patients (84%). Thirteen patients (21%) required mechanical ventilation preoperatively. Fifty-five patients underwent HSCT for hematologic malignancies, and 4 (7%) relapsed after lung transplantation. The 5-year survival rate was 64.2%. In a multivariable analysis, patients younger than 45 years and those with the same donor for both procedures exhibited significantly better survival (P = 0.012 and 0.041, respectively). Conclusions. Lung transplantation for pulmonary complications after HSCTwas performed safely and yielded better survival, especially in younger recipients for whom both lung transplantation and HSCT involved the same donor.