Marginal donor lungs: A reassessment
Marginal donor lungs: A reassessment
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DOI：
10.1067/mtc.2002.120345
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发表时间：
2002-03-01
影响因子：
6
通讯作者：
Keshavjee, SH
中科院分区：
文献类型：
--
作者：
Pierre, AF;Sekine, Y;Keshavjee, SH
目的：肺移植因供体缺乏而受到限制。为了克服这个问题，许多项目已经开始使用边际或扩展捐助者后，报告表明，没有额外的风险等效的结果。由于我们使用的扩展供体肺增加，我们的受体选择标准扩大，我们认为这是适当的，以重新评估结果与扩展供体肺与标准供体肺和受体以外的结果目前公认的guidelines.Methods：我们进行了回顾性分析128个连续肺或心肺移植从1997年1月1日至2000年6月30日。主要终点为30天死亡率。如果符合以下任何一项标准，则认为供体延长：年龄大于55岁，吸烟超过20包-年，存在胸部X线片浸润，PO 2小于300 mm Hg，或支气管镜检查显示脓性分泌物。指南和nonguideline收件人定义的基础上，以前公布的critics.Results：共123捐助者，63（51%）被延长。48名供体不符合1项标准，10名不符合2项标准，5名不符合3项标准。进行了128例移植。标准供体组的30天死亡率为4（6.2%），65人对11人（17.5%）的63名扩大供体组（P =.047）.结论：虽然许多延长的供体肺将导致可接受的术后功能，在使用某些扩大的供体肺时需要谨慎，因为这类肺的早期死亡率似乎有所增加的收件人。非指导性受体的早期死亡率似乎是可以接受的，除非他们接受了扩展的供体肺。
Objective: Lung transplantation is limited by the shortage of suitable donors. Toovercome this problem, many programs have begun to use marginal or extended donors after reports suggesting equivalent outcomes with no additional risk. As our use of extended donor lungs increased and our recipient selection criteria expanded, we believed it was appropriate to reevaluate outcomes with extended donor lungs compared with outcomes with standard donor lungs and recipients outside of the currently accepted guidelines.Methods: We performed a retrospective review of 128 consecutive lung or heart-lung transplants from January 1, 1997, to June 30, 2000. The primary endpoint was 30-day mortality. Donors were considered extended if any one of the following criteria were met: age greater than 55 years, smoking longer than 20 pack-years, presence of chest radiographic film infiltrate, PO2 Of less than 300 mm Hg, or purulent secretions on bronchoscopy. Guideline and nonguideline recipients were defined on the basis of previously published criteria.Results: Of a total of 123 donors, 63 (51%) were extended. Forty-eight donors failed 1 criterion, 10 failed 2 criteria, and 5 failed 3 criteria. One hundred twenty-eight transplants were performed. The 30-day mortality for the standard donor group was 4 (6.2%) of 65 versus 11 (17.5%) of 63 for the extended donor group (P =.047).Conclusions: Although many extended donor lungs will result in acceptable postoperative function, caution needs to be exercised in the uses of certain extended donor lungs because there seems to be an increased early mortality rate in that group of recipients. Nonguideline recipients appear to have acceptable early mortality, except when they received extended donor lungs.