Supranormal Expiratory Airflow after Bilateral Lung Transplantation Is Associated with Improved Survival
Supranormal Expiratory Airflow after Bilateral Lung Transplantation Is Associated with Improved Survival
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DOI：
10.1164/rccm.201004-0593oc
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发表时间：
2011-01-01
影响因子：
24.7
通讯作者：
Brower, Roy G.
中科院分区：
文献类型：
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作者：
Eberlein, Michael;Permutt, Solbert;Brower, Roy G.
基本原理 一些双侧肺移植 (BLT) 和心肺移植 (HLT) 患者的血流量环 (FVL) 表明，在没有可识别原因的情况下存在可变的胸外梗阻。这些 FVL 通常具有超常呼气流量和正常吸气流量（SUPRA 模式）。 目的： 描述 SUPRA 模式与预测供体和受体肺容量、气道大小和生存率的关系。 方法： 我们对成人 BLT/HLT 患者进行回顾性评估。我们将 SUPRA FVL 模式定义为：(1) 中期肺活量呼气与吸气流量比 (Ve50:Vi50) > 1.0，(2) 缺乏可识别的胸外梗阻原因，(3) Ve50/FVC >= 1.5 s(-1)。我们通过将供体 pTLC 除以受体 pTLC 来计算预测的总肺容量 (pTLC) 比率。我们通过胸部计算机断层扫描测量了气道管腔面积。我们比较了有和没有 SUPRA 模式的患者的生存率。测量和主要结果：在 89 名符合分析资格的患者中，56% 出现 SUPRA FVL 模式。 SUPRA 和非 SUPRA 患者的 pTLC 比率分别为 1.11 和 0.99 (P = 0.004)。较高的 pTLC 比率与 SUPRA 模式的概率增加相关 (P = 0.0072)。 SUPRA 患者的气道管腔面积更大 (P = 0.009)。 SUPRA 队列的生存率更高 (P = 0.009)。结论：SUPRA FVL 模式在 BLT/HLT 患者中常见。 SUPRA 患者的高呼气流量可能是由于肺弹性回缩增加或气道阻力减少造成的，这两者都可能是由 pTLC 不匹配引起的。 SUPRA 队列中生存率的提高表明了改善 BLT/HLT 患者预后的潜在治疗方法。
Rationale Flow volume loops (FVL) in some bilateral lung transplant (BLT) and heart-lung transplant (HLT) patients suggest variable extrathoracic obstruction in the absence of identifiable causes. These FVLs usually have supranormal expiratory and normal inspiratory flow rates (SUPRA pattern).Objectives: Characterize the relationship of the SUPRA pattern to predicted donor and recipient lung volumes, airway size, and survival.Methods: We performed a retrospective review of adult BLT/HLT patients. We defined the SUPRA FVL pattern as: (1) mid-vital capacity expiratory to inspiratory flow ratio (Ve50:Vi50) > 1.0, (2) absence of identifiable causes of extrathoracic obstruction, and (3) Ve50/FVC >= 1.5 s(-1). We calculated predicted total lung capacity (pTLC) ratio by dividing the donor pTLC by the recipient pTLC. We measured airway luminal areas on thoracic computer tomographic scans. We compared survival in patients with and without the SUPRA pattern.Measurements and Main Results: The SUPRA FVL pattern occurred in 56% of the 89 patients who qualified for the analysis. The pTLC ratio of SUPRA and non-SUPRA patients was 1.11 and 0.99, respectively (P = 0.004). A higher pTLC ratio was correlated with increased probability of the SUPRA pattern (P = 0.0072). Airway luminal areas were larger in SUPRA patients (P = 0.009). Survival was better in the SUPRA cohort (P = 0.009).Conclusions: The SUPRA FVL pattern was frequent in BLT/HLT patients. High expiratory flows in SUPRA patients could result from increased lung elastic recoil or reduced airway resistance, both of which could be caused by the pTLC mismatch. Improved survival in the SUPRA cohort suggests potential therapeutic approaches to improve outcomes in BLT/HLT patients.