Comparison of Outcomes From Smoking and Nonsmoking Donors: Thirteen-Year Experience
Comparison of Outcomes From Smoking and Nonsmoking Donors: Thirteen-Year Experience
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DOI：
10.1016/j.athoracsur.2010.07.073
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发表时间：
2010-11-01
影响因子：
4.6
通讯作者：
Parmar, Jasvir
中科院分区：
文献类型：
--
作者：
Berman, Marius;Goldsmith, Kim;Parmar, Jasvir
背景资料。肺移植仍然是各种终末期肺部疾病的最佳治疗选择。对有限捐赠者的压力导致使用扩展的标准捐赠者。其中一个方面是放开了吸烟捐赠者(SMD)的使用。这项研究是对1995年4月至2008年8月间在一家研究所进行的肺移植的回顾。我们考察了供者吸烟对供者短期和长期存活率的影响，以及供者和供者的人口学特征，如缺血时间、巨细胞病毒状态、排斥反应和感染率、通风和重症监护住院时间。终点是生存、感染和排斥。在这13年间，共进行了454例肺移植手术。其中424人(93.4%)有吸烟史(SMD，n=184；NSmD，n=240)。71名患者在移植后3个月内死亡，353名患者在移植后3个月存活。SMD组前3个月内的死亡率显著高于SMD组(21%比13%，优势比1.9，风险比3.3，p=0.04)。SMD和NSMD肺移植后3个月和1年的排斥反应和感染率差异无统计学意义(p=0.51和0.09)。尽管接受SMD肺移植的患者通气量超过10小时的几率更高，但几率仅增加了20%，这在统计学上没有统计学意义。来自SMD的受试者在重症监护病房的住院时间显著延长(优势比1.9p=0.002)。几乎没有证据表明SMD对闭塞性毛细支气管炎的发生有影响。在这一大群患者中，捐献者吸烟史对早期存活率有影响，但对长期存活率没有影响。这种早期死亡的原因与感染和排斥无关。然而，这些数据表明，使用吸烟者的供体肺的总体结果是可以接受的，特别是在供体器官有限的当今时代。
Background. Lung transplantation remains the best treatment option for a variety of end-stage lung diseases. Pressure on the limited donor pool has led to the use of extended criteria donors. One aspect of this has been the liberalization of the use of smoking donors (SmD).Methods. This study is a retrospective review of lung transplants performed between April 1995 and August 2008 at a single institute. We examined the impact of donor smoking on short-term and long-term survival in relationship to recipient and donor demographics such as ischemic time, cytomegalovirus status, rates of rejection and infection, ventilation, and intensive care stay. Endpoints were survival, infection, and rejection.Results. During this 13-year period, 454 lung transplants were performed. Smoking history was available on 424 (93.4%) of these (SmD, n = 184; NSmD, n = 240). Seventy-one patients died within 3 months of transplant leaving 353 alive at 3 months posttransplant. Fatalities within the first 3 months were significantly higher in the SmD group (21% vs 13%, odds ratio 1.9, hazard ratio 3.3, p = 0.04). No significant difference in rejection and infection rates between recipients of lungs from SmD and NSmD at 3 months and at 1 year posttransplantation (p = 0.51 and 0.09) was found. Although recipients of lungs from SmD had higher odds of ventilation for more than 10 hours, the odds were only increased by 20%, which was not statistically significant. Recipients from SmD had significantly longer stays in the intensive care (odds ratio 1.9, p = 0.002). There was little evidence for an effect of SmD on the development of bronchiolitis obliterans.Conclusions. In this large cohort of patients, donor smoking history has an effect on early survival but no effect on long-term survival. The cause of this early mortality is independent of infection and rejection. However, these data suggest that overall outcomes from the use of donor lungs from smokers are acceptable, particularly in the current era with limited donor organs.