Primary graft dysfunction and long-term pulmonary function after lung transplantation
Primary graft dysfunction and long-term pulmonary function after lung transplantation
复制标题
DOI：
10.1016/j.healun.2007.07.018
复制
发表时间：
2007-10-01
影响因子：
8.9
通讯作者：
Dahlberg, Peter S.
中科院分区：
文献类型：
--
作者：
Whitson, Bryan A.;Prekker, Matthew E.;Dahlberg, Peter S.
背景：严重的原发移植物功能障碍(PGD)与肺移植(LTX)后不良的早期结果相关。关于严重PGD对肺功能的挥之不去的影响，我们知之甚少。该研究的目的是确定在围手术期发生严重的原发移植物功能障碍是否与长期存活率降低或长期肺功能减退有关。方法：对1992-2005年间接受LTX移植的患者进行了回顾。移植后48小时内PGD的严重程度根据国际心肺移植协会的标准进行分级。每年评估肺功能，并通过测量1秒用力呼气容量(FEV1)确定闭塞性细支气管炎综合征(BOS)。结果：共有374例患者在移植后至少存活90天。3级患者的总体生存率较差：3级患者5年和10年生存率分别为51%和11%，2级患者5年和10年生存率分别为%和35%，0~1级患者5年和10年生存率分别为66%和38%(P=0.001)。在双肺移植受者中，3级PGD患者的无BOS生存率低于0~2级受者，但在单肺受者中并非如此。发展为3级PGD的双侧肺移植受者的平均FEV1显著低于未发展为3级PGD的受者。结论：术后早期发生3级PGD对围术期存活的双侧肺移植受者的远期存活率、无BOS存活率和肺功能均有不良影响。心肺移植杂志2007；26：1004-11。版权所有(C)2007，国际心肺移植学会。
Background: Severe primary graft dysfunction (PGD) is associated with poor early outcomes after lung transplantation (LTx). Less is known about lingering effects of severe PGD on pulmonary function. The study's aim was to determine whether development of severe primary graft dysfunction in the perioperative period was associated with reduced long term rates of survival or with diminished long term pulmonary function.Methods: A retrospective review was performed on LTx recipients who received their transplant during the period from 1992 through 2005. PGD severity over the first 48 hours post-transplant was graded using International Society for Heart Lung Transplantation criteria. Pulmonary function was evaluated yearly, and bronchiolitis obliterans syndrome (BOS) was determined from measurements of forced expiratory volume in 1 second (FEV1).Results: A total of 374 patients survived at least 90 days post-transplant. Overall survival rates were worse in patients with Grade 3 PGD: 51% at 5 years and 11% at 10 years for patients with Grade 3 PGD; 64% at 5 years and 35% at 10 years for those with Grade 2 PGD; and 66% at 5 years and 38% at 10 years for Grade 0 to 1 PGD (p = 0.001). BOS-free survival rate for patients with Grade 3 PGD was lower compared to those with Grade 0 to 2 for bilateral lung recipients, but not for single-lung recipients. Bilateral lung recipients who developed Grade 3 PGD had a significantly worse mean FEV1 than those who did not. For single-lung recipients, PGD grade did not correlate with post-transplant pulmonary function.Conclusions: Development of Grade 3 PGD in the early post-operative period negatively affects long-term survival, BOS-free survival and pulmonary function of bilateral lung transplant recipients who survive the peri-operative period. J Heart Lung Transplant 2007; 26:1004-11. Copyright (c) 2007 by the International Society for Heart and Lung Transplantation.