Comparison of living-donor lobar lung transplantation and cadaveric lung transplantation for pulmonary hypertension
Comparison of living-donor lobar lung transplantation and cadaveric lung transplantation for pulmonary hypertension
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活体肺叶移植与尸体肺移植治疗肺动脉高压的比较
DOI：
10.1093/ejcts/ezad024
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发表时间：
2023
影响因子：
3.4
通讯作者：
Date Hiroshi
中科院分区：
文献类型：
--
作者：
Kayawake Hidenao;Tanaka Satona;Yamada Yoshito;Baba Shiro;Kinoshita Hideyuki;Yamazaki Kazuhiro;Ikeda Tadashi;Minatoya Kenji;Yutaka Yojiro;Hamaji Masatsugu;Ohsumi Akihiro;Nakajima Daisuke;Date Hiroshi
目的活体供体大叶肺移植（LDLLT）是一种挽救包括肺动脉高压（PH）在内的各种肺部疾病危重患者生命的手术。然而，对于仅植入1或2个肺叶的LDLLT术后心力衰竭伴肺水肿的发展存在担忧。本研究旨在比较LDLLT与尸体肺移植（CLT）在PH患者的术前条件和术后结果。方法2008年至2021年间，34例肺移植治疗PH，包括12例ldllt（5例单侧，7例双侧）和22例双侧clt。回顾性比较两种手术的术前变量和术后结果。结果LDLLT患者的术前活动能力较差（41.7%比100%，P< 0.001），世界卫生组织4级患者比例较高（83.3%比18.2%，P< 0.001），平均肺动脉压较高（74.4比57.3 mmHg，P= 0.040）， LDLLT患者比CLT患者更虚弱。然而，两组之间的医院死亡率相似（分别为8.3%对9.1%,P < 0.99）。两组患者的5年总生存率相近（90.0% vs 76.3%，P= 0.489）。结论：虽然LDLLT患者的术前条件比CLT患者差，接受的移植物也比CLT患者小，但LDLLT患者的围手术期结局和预后与CLT患者相似。LDLLT是PH患者可行的治疗选择。
OBJECTIVESLiving-donor lobar lung transplantation (LDLLT) is a life-saving procedure for critically ill patients with various lung diseases, including pulmonary hypertension (PH). However, there are concerns regarding the development of heart failure with pulmonary oedema after LDLLT in which only 1 or 2 lobes are implanted. This study aimed to compare the preoperative conditions and postoperative outcomes of LDLLT with those of cadaveric lung transplantation (CLT) in PH patients.METHODSBetween 2008 and 2021, 34 lung transplants for PH, including 12 LDLLTs (5 single and 7 bilateral) and 22 bilateral CLTs, were performed. Preoperative variables and postoperative outcomes were retrospectively compared between the 2 procedures.RESULTSBased on the preoperative variables of less ambulatory ability (41.7% vs 100%,P< 0.001), a higher proportion of World Health Organization class 4 (83.3% vs 18.2%,P< 0.001) and higher mean pulmonary artery pressure (74.4 vs 57.3 mmHg,P= 0.040), LDLLT patients were more debilitated than CLT patients. Nevertheless, hospital death was similar between the 2 groups (8.3% vs 9.1%,P> 0.99, respectively). Furthermore, the 5-year overall survival rate was similar between the 2 groups (90.0% vs 76.3%,P= 0.489).CONCLUSIONSAlthough LDLLT patients with PH had worse preoperative conditions and received smaller grafts than CLT patients, LDLLT patients demonstrated similar perioperative outcomes and prognoses as CLT patients. LDLLT is a viable treatment option for patients with PH.