Improved survival after living-donor lobar lung transplantation
Improved survival after living-donor lobar lung transplantation
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DOI：
10.1016/j.jtcvs.2004.07.032
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发表时间：
2004-12-01
影响因子：
6
通讯作者：
Shimizu, N
中科院分区：
文献类型：
--
作者：
Date, H;Aoe, M;Shimizu, N
目的：活体大叶肺移植的存活率与身体肺移植相似。方法：1998年10月至2004年4月，对30例各种肺部疾病的危重患者施行活体大叶肺移植，其中5例(17%)使用呼吸机。年龄8~55岁，平均30.4岁。术后处理包括缓慢脱离呼吸机、相对小剂量的免疫抑制剂，以及根据X线和临床表现仔细监测排斥反应。结果：平均机械通气时间15.4天，重症监护病房住院时间23.5天，住院时间64.6天。根据临床判断，每名患者平均发生1.5次急性排斥反应，但在第一个月只有一名患者发生感染。尽管术后过程复杂，但所有患者均在没有吸氧的情况下出院。4例患者有单侧闭塞性细支气管炎综合征，但其1秒用力呼气量的下降在9个月内停止。30名受助者目前全部在世，随访期为1至66个月。所有供者均恢复了原来的生活方式。结论：活体供肺肺移植适用于预期寿命非常有限的儿童和成人患者。它可能比传统的身体肺移植提供更好的存活率。
Objective: Survival after living-donor lobar lung transplantation has been reported to be similar to that after cadaveric lung transplantation. The purpose of this study was to summarize our 5-year experience of living-donor lobar lung transplantation for critically ill patients.Methods: Between October 1998 and April 2004, we performed living-donor lobar lung transplantation in 30 critically ill patients with various lung diseases, including 5 (17%) patients on a ventilator. Mean age was 30.4 years (range, 8-55 years). Postoperative management included slow weaning from a ventilator, relatively low-dose immunosuppressants, and careful rejection monitoring on the basis of radiographic and clinical findings without transbronchial lung biopsy.Results: The average duration of mechanical ventilation was 15.4 days, intensive care unit stay was 23.5 days, and hospital stay was 64.6 days. Clinically judged acute rejection occurred at an average rate of 1.5 episodes per patient, but infection occurred in only one patient during the first month. In spite of the complicated postoperative course, all patients were discharged without oxygen inhalation. Four patients had unilateral bronchiolitis obliterans syndrome, but the decrease in their forced expiratory volume in 1 second values stopped within 9 months. All 30 recipients are currently alive, with a follow-up period of 1 to 66 months. All donors have returned to their previous lifestyles.Conclusions: Living-donor lobar lung transplantation can be applied to both pediatric and adult patients with very limited life expectancies. It might provide better survival than conventional cadaveric lung transplantation.