Outcomes after lung retransplantation in the modern era
Outcomes after lung retransplantation in the modern era
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DOI：
10.1164/rccm.200707-1132oc
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发表时间：
2008-01-01
影响因子：
24.7
通讯作者：
Barr, Mark L.
中科院分区：
文献类型：
--
作者：
Kawut, Steven M.;Lederer, David J.;Barr, Mark L.
理由：现代再移植肺受者的特征和生存估计尚不清楚。目的：将现代再移植肺患者与历史上再移植患者进行比较，将现代再移植患者与初次肺移植患者进行比较，并确定再肺移植后死亡风险的预测因素。方法：我们对 2001 年 1 月至 2006 年 5 月期间接受肺再移植的患者进行了回顾性队列研究。美国（现代再移植队列）。该队列的特征和存活率与 1990 年 1 月至 2000 年 12 月期间接受首次肺再移植的患者（历史性再移植队列）和 2001 年 1 月至 2006 年 5 月期间接受初次肺移植的患者（现代初始移植队列）进行比较。测量和主要结果：与历史性再移植队列（n = 205）相比，现代再移植受者（n = 205）的死亡风险较低。 184)（风险比，0.7；95% 置信区间，0.5-0.9；P = 0.006）。然而，现代再移植受者的死亡风险高于接受初次肺移植的患者 (n = 5,657)（风险比，1.3；95% 置信区间，1.2-1.5；P = 0.001），这似乎是由于某些合并症的患病率较高所致。初次移植手术后不到 30 天的再移植与较差的生存率相关。结论：肺再移植后的结果有所改善；然而，与初次移植手术相比，再次移植仍然会增加死亡风险。初次移植后早期再移植的死亡风险特别高。
Rationale: Characteristics of and survival estimates for recipients of lung retransplantation in the modern era are unknown.Objectives: To compare lung retransplant patients in the modern era with historical retransplant patients, to compare retransplant patients with initial transplant patients in the modern era, and to determine the predictors of the risk of death after lung retransplantation.Methods: We performed a retrospective cohort study of patients who underwent lung retransplantation between January 2001 and May 2006 in the United States (modern retransplant cohort). The characteristics and survival of this cohort were compared with those of patients who underwent first lung retransplantation between January 1990 and December 2000 (historical retransplant cohort) and patients who underwent initial lung transplantation between January 2001 and May 2006 (modern initial transplant cohort).Measurements and Main Results: Modern retransplant recipients (n = 205) had a lower risk of death compared with that of the historical retransplant cohort (n = 184) (hazard ratio, 0.7; 95% confidence interval, 0.5-0.9; P = 0.006). However, modern retransplant recipients had a higher risk of death than that of patients who underwent initial lung transplantation (n = 5,657) (hazard ratio, 1.3; 95% confidence interval, 1.2-1.5; P = 0.001), which appeared to be explained by a higher prevalence of certain comorbidities. Retransplantation at less than 30 days after the initial transplant procedure was associated with worse survival.Conclusions: Outcomes after lung retransplantation have improved; however retransplantation continues to pose an increased risk of death compared with the initial transplant procedure. Retransplantation early after, the initial transplant poses a particularly high mortality risk.