Two Decades of Lung Retransplantation: A Single-Center Experience
Two Decades of Lung Retransplantation: A Single-Center Experience
复制标题
DOI：
10.1016/j.athoracsur.2016.09.107
复制
发表时间：
2017-04-01
影响因子：
4.6
通讯作者：
Machuca, Tiago N.
中科院分区：
文献类型：
--
作者：
Hall, David J.;Belli, Erol V.;Machuca, Tiago N.
背景再次肺移植（ReTx）包括越来越多的肺移植，最近已经显示出改善的结果。本研究的目的是确定影响肺ReTx后总生存率的危险因素。联合器官共享网络数据库用于识别1995年至2014年在我们机构接受肺移植的患者。在总共进行的542例肺移植中，87例（16.1%）为ReTx。主要结局是总生存期。采用多因素考克斯回归模型分析受者和供者特征对存活率的影响。在接受ReTx的患者中，中位生存期为2年。较差生存率的预测因素包括受体年龄在50至60岁之间（相对风险，4.3; p = 0.02）或大于60岁（相对风险，10.2; p < 0.001），以及ReTx时间小于2年（相对风险，3.8; p = 0.01）。闭塞性细支气管炎综合征的ReTx治疗的中位生存期长于限制性慢性肺移植物功能障碍（2.7年vs 0.9年; p = 0.055）。在肺分配评分开始后，ReTx患者的总生存率没有显著差异（p = 0.21）。肺ReTx的结果明显比初次移植差，但可能适用于具有某些诊断的精心选择的患者。年龄大于50岁或初次肺移植2年内的患者的肺ReTx与生存率降低相关。进一步的工作是必要的，以确定谁受益最大的患者从ReTx。(C)2017胸外科医师协会
Background. Lung retransplantation (ReTx) comprises an increasing share of lung transplants and recently has shown improved outcomes. The aim of this study was to identify risk factors affecting overall survival after pulmonary ReTx.Methods. The United Network for Organ Sharing database was used to identify patients undergoing lung transplantation at our institution from 1995 to 2014. Of the total 542 lung transplants performed, 87 (16.1%) were ReTxs. The primary outcome was overall survival. Multivariate Cox regression models were used to assess the effect of recipient and donor characteristics on survival.Results. Of the patients who underwent ReTx, median survival was 2 years. Predictors of worse survival include recipient age between 50 and 60 years (relative risk, 4.3; p = 0.02) or older than 60 years (relative risk, 10.2; p < 0.001), and time to ReTx of less than 2 years (relative risk, 3.8; p = 0.01). ReTx for bronchiolitis obliterans syndrome had longer median survival than for restrictive chronic lung allograft dysfunction (2.7 years vs 0.9 years; p = 0.055). Overall survival of ReTx patients after initiation of the lung allocation score was not significantly different (p = 0.21).Conclusions. Lung ReTx outcomes are significantly worse than for primary transplantation but may be appropriate in well-selected patients with certain diagnoses. Lung ReTx in patients older than 50 years or within 2 years of primary lung transplantation was associated with decreased survival. Further work is warranted to identify patients who benefit most from ReTx. (C) 2017 by The Society of Thoracic Surgeons