Unilateral chronic lung allograft dysfunction is a characteristic of bilateral living-donor lobar lung transplantation
Unilateral chronic lung allograft dysfunction is a characteristic of bilateral living-donor lobar lung transplantation
复制标题
DOI：
10.1093/ejcts/ezu463
复制
发表时间：
2015-09-01
影响因子：
3.4
通讯作者：
Date, Hiroshi
中科院分区：
文献类型：
--
作者：
Miyamoto, Ei;Chen, Fengshi;Date, Hiroshi
目的：活体供者肺叶移植（LDLLT）已被确立为不能等待尸体肺移植的危重患者的挽救生命的手术。慢性肺移植物功能障碍（CLAD）是肺移植后期发病和死亡的主要原因。尸体肺移植中CLAD的研究已被广泛报道，但关于LDLLT后CLAD的报道很少。本研究的目的是确定LDLLT后CLAD的患病率、特征和预后。方法：2008年6月至2013年12月期间，在京都大学医院LDLLT后存活超过3个月的38例患者中，8例（21%）被诊断为CLAD。LDLLT后的平均随访期为33个月。回顾性分析截至2014年5月38例患者的临床病程、肺功能和影像学表现。LDLLT的中位年龄为31岁，LDLLT和CLAD初始诊断之间的中位间隔为23个月。在8例发生CLAD的患者中，2例患者接受了右侧单LDLLT，6例患者接受了双侧LDLLT。前2例分别存活44个月和47个月。6例双侧LDLLT患者中有5例在根据通气描记术初步诊断时发生单侧CLAD。在这5例患者中，有3例患者的CLAD进展通过治疗停止，治疗后的中位随访期为33个月。在其余2/5例患者中，CLAD异时性进展至对侧肺; 1例患者在未补充氧气的情况下存活，但另1例患者在首次治疗后3年需要再次进行LDLLT。一名患者与双边CLAD在检测时死于疾病进展4年后LDLLT.CONCLUSIONS：尽管相对较短的观察时间，CLAD开发约五分之一的患者谁生存超过3个月后LDLLT。在双侧LDLLT中，CLAD在大多数情况下单侧发展，这可能是长期有益的，因为未受影响的对侧肺可能起储库的作用。
OBJECTIVES: Living-donor lobar lung transplantation (LDLLT) has been established as a life-saving procedure for critically ill patients who cannot wait for cadaveric lung transplantation. Chronic lung allograft dysfunction (CLAD) is the main cause of late morbidity and mortality in lung transplantation. Studies on CLAD in cadaveric lung transplantation have been extensively reported, but few reports have been reported concerning CLAD after LDLLT. The aim of this study was to determine the prevalence, characteristics and prognosis of CLAD after LDLLT.METHODS: Among 38 patients who survived more than 3 months after LDLLT at Kyoto University Hospital between June 2008 and December 2013, 8 patients (21%) were diagnosed with CLAD. The mean follow-up period after LDLLT was 33 months. Clinical course, pulmonary function and radiological findings were reviewed retrospectively in all the 38 patients as of May 2014.RESULTS: Six patients were female and 2 were male. The median age at LDLLT was 31 years, and the median interval between LDLLT and the initial diagnosis of CLAD was 23 months. Among 8 patients who developed CLAD, 2 patients underwent right single LDLLT and 6 patients underwent bilateral LDLLT. The former 2 patients survived 44 and 47 months after the treatment. Five out of 6 patients with bilateral LDLLT developed unilateral CLAD at the time of initial diagnosis according to ventilation scintigraphy. In 3 of these 5 patients, the progression of CLAD was halted by treatment, and the median follow-up period of 33 months after treatment. In the remaining 2 of 5 patients, CLAD progressed to the contralateral lung metachronously; 1 patient survived without oxygen supplement, but the other patient required reperformance of LDLLT 3 years after the first one. One patient with bilateral CLAD at the time of detection died of disease progression 4 years after LDLLT.CONCLUSIONS: Despite a relatively short observation time, CLAD developed in approximately one-fifth of the patients who survived more than 3 months after LDLLT. In bilateral LDLLT, CLAD developed unilaterally in most cases, which might be beneficial in the long term because the unaffected contralateral lung may function as a reservoir.