Effects of sinus surgery on lung transplantation outcomes in cystic fibrosis
Effects of sinus surgery on lung transplantation outcomes in cystic fibrosis
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DOI：
10.2500/ajr.2008.22.3146
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发表时间：
2008-03-01
期刊：
影响因子：
--
通讯作者：
Hwang, Peter H.
中科院分区：
文献类型：
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作者：
Leung, Man-Kit;Rachakonda, Leelanand;Hwang, Peter H.
背景：对于肺移植的囊性纤维化(CF)患者，提倡在移植前进行鼻窦手术，以避免移植肺中的细菌播种。这项研究回顾了17年来在一个主要的移植中心接受移植前鼻窦手术的患者的经验。方法：对1988-2005年间在斯坦福医学中心接受心肺或肺移植的所有CF患者进行回顾性图表回顾。结果：87例CF移植受者接受了术前鼻窦手术，87%(n=59168)的患者在支气管肺泡灌洗液和鼻窦抽吸物的培养上显示出移植物的再生。术后中位时间为19天。鼻窦培养的菌群在类型和流行程度上与BAL培养的菌群相似。与已发表的一系列未进行移植前鼻窦手术的可比队列相比，假单胞菌再集落的发生率在统计学上没有显著差异。重新殖民化的时间也相似。我们队列中的存活率与全国CF肺移植患者的存活率相似。结论：尽管进行了移植前的鼻窦手术，移植肺的再定植发生得普遍而迅速，其菌群谱类似于鼻窦、菌群。接受预防性鼻窦手术的CF患者的存活率与那些不常规进行预防性鼻窦手术的中心的患者相似。移植前鼻窦手术似乎不能阻止肺移植物再分化，而且与总体生存益处无关。
Background: In cystic fibrosis (CF) patients who are candidates for lung transplant, pretransplant sinus surgery has been advocated to avoid bacterial seeding of the transplanted lungs. This study reviews the 17-year experience of pretransplant sinus surgery among CF patients at a major transplant center.Methods: Retrospective chart review was performed in all CF patients who underwent heart-lung or lung transplantation at Stanford Medical Center between 1988 and 2005. Postoperative culture data from bronchoalveolar lavage (BAL) and sinus aspirates were evaluated, in addition to survival data.Results: Eighty-seven CF transplant recipients underwent pretransplant sinus surgery, 87% (n = 59168) of patients showed recolonization of the lung grafts with Pseudomonas on BAL cultures. The median postoperative time to recolonization was 19 days. Bacterial floras cultured from sinuses were similar in type and prevalence as the floras cultured from BAL. When compared with published series of comparable cohorts in which pretransplant sinus surgery was not performed, there was no statistically significant difference in the prevalence of Pseudomonas recolonization. Times to recolonization also were similar. Survival rates in our cohort were similar to national survival rates for CF lung transplant recipients.Conclusion: Despite pretransplant sinus surgery, recolonization of lung grafts occurs commonly and rapidly with a spectrum of flora that mimics the sinus, flora. Survival rates of CF patients who undergo prophylactic sinus surgery are similar to those from centers where Prophylactic Sinus surgery is not performed routinely. Pretransplant sinus surgery does not appear to prevent lung graft recolonization and is not associated with overall survival benefit.