Clinical features and outcomes of unplanned single lung transplants.
Clinical features and outcomes of unplanned single lung transplants.
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非计划单肺移植的临床特征和结果。
DOI：
10.1016/j.jtcvs.2022.01.055
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Kreisel,
中科院分区：
文献类型：
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作者：
Terada,Yuriko;Takahashi,Tsuyoshi;Hachem,RamseyR;Liu,Jingxia;Witt,ChadA;Byers,DerekE;Guillamet,RodrigoVazquez;Kulkarni,HrishikeshS;Nava,RubenG;Kozower,BenjaminD;Meyers,BryanF;Pasque,MichaelK;Patterson,GAlexander;Kreisel,
目的单肺移植或双肺移植通常在术前决定。我们之前曾报道过，在双肺移植流产的情况下，有一定比例的单肺移植患者意外地进行了手术，这些患者短期预后较差的风险可能更高。计划外单肺移植的长期结果尚不清楚。方法对2000年至2020年的单中心肺移植数据库进行分析。回顾手术记录，将单肺移植分为计划组和非计划组。对计划外单肺移植进行根本原因分析。结果1326例肺移植中，双肺移植1265例（95%），单肺移植61例（5%），其中计划移植22例（36%），计划外移植39例（64%）。移植的基本指征有显著差异；计划单肺移植：慢性阻塞性肺疾病（55%）和特发性肺纤维化（45%）；计划外单肺移植：慢性阻塞性肺疾病（23%）、特发性肺纤维化（39%）和闭塞性细支气管炎综合征（13%）。计划外单肺移植的主要原因是供体相关（3.7.7%）、受体相关（31.80%）和供体和受体相关因素（5.13%）。无计划单肺移植在术中更有可能需要体外循环（计划：4/ 22,18% vs计划外：20/ 39,51%），但缺血时间更短（计划：251±58分钟vs计划外：221±48分钟）。计划组5年总生存率为53%，非计划组为58% （P= .323）。慢性同种异体肺移植无功能障碍生存率无差异（P= .995）。结论在双肺移植流产的情况下，未经计划的单肺移植可能具有可接受的长期预后。
ObjectiveThe decision to perform single lung transplants or double lung transplants is usually made before the operation. We have previously reported that a proportion of single lung transplants were unexpectedly performed in the setting of an aborted double lung transplant, and these patients may be at a higher risk of worse short-term outcomes. Long-term outcomes in unplanned single lung transplants remain unknown.MethodsWe analyzed a single-center database of lung transplants from 2000 to 2020. Single lung transplants were classified into planned and unplanned groups after reviewing operative notes. Root cause analysis was performed for unplanned single lung transplants.ResultsOf the 1326 lung transplants, 1265 (95%) were double lung transplants and 61 (5%) were single lung transplants (22 planned [36%], 39 unplanned [64%]). Underlying indications for transplant were significantly different; planned single lung transplant: chronic obstructive pulmonary disease (55%) and idiopathic pulmonary fibrosis (45%); unplanned single lung transplants: chronic obstructive pulmonary disease (23%), idiopathic pulmonary fibrosis (39%), and bronchiolitis obliterans syndrome (13%). The primary reasons for unplanned single lung transplant were donor-related (3, 7.7%), recipient-related (31, 80%), and donor and recipient-related factors (5, 13%). Unplanned single lung transplants were more likely to require cardiopulmonary bypass during the operation (planned: 4/22, 18% vs unplanned: 20/39, 51%) but had shorter ischemic times (planned: 251 ± 58 minutes vs unplanned: 221 ± 48 minutes). The 5-year overall survival was 53% in the planned and 58% in the unplanned groups, respectively (P= .323). No difference in chronic lung allograft dysfunction–free survival (P= .995) was observed.ConclusionsUnplanned single lung transplants in the setting of aborted double lung transplant may be associated with acceptable long-term outcomes.