Survival After Bilateral Versus Single-Lung Transplantation for Idiopathic Pulmonary Fibrosis
Survival After Bilateral Versus Single-Lung Transplantation for Idiopathic Pulmonary Fibrosis
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DOI：
10.7326/0003-4819-151-11-200912010-00004
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发表时间：
2009-12-01
影响因子：
39.2
通讯作者：
Mal, Herve
中科院分区：
文献类型：
--
作者：
Thabut, Gabriel;Christie, Jason D.;Mal, Herve
背景资料：终末期特发性肺纤维化（IPF）患者越来越多地接受双侧肺移植而不是单肺移植。目的：比较IPF患者单肺移植和双侧肺移植后的生存率。设计：来自器官共享注册联合网络的数据分析。设置：美国的移植中心。患者：1987年至2009年间，3327例IPF患者接受了单肺（2146例患者[64.5%]）或双侧（1181例患者[35.5%]）肺移植。测量：肺移植后的生存时间和死亡原因。选择偏倚由多变量风险调整、倾向评分风险调整和基于倾向的matching.Results解释：双侧肺移植后中位生存时间长于单肺移植（5.2年[CI，4.3 - 6.7年] vs. 3.8年[CI，3.6 - 4.1年]; P < 0.001）。然而，在校正基线差异后，两种手术的生存时间没有差异，在不同的分析中，双侧移植死亡率的校正风险比（HR）范围为0.89（95% CI，0.79 - 1.02）至0.96（CI，0.77 - 1.20）。双侧肺移植似乎在第一年内导致损害（HR，1.18 [CI，0.98至1.42]），但此后生存获益（HR，0.72 [CI，0.59至0.87]）。原发性移植物衰竭是双肺移植而非单肺移植患者更常见的死亡原因（3.7% vs. 1.9%; P = 0.002）。在接受单肺移植而不是双肺移植的患者中，癌症是更常见的死亡原因（单移植与双移植受者死亡的未校正HR，3.60 [CI，2.16至6.05]; P < 0.001）。局限性：死亡原因是在没有裁定委员会的情况下确定的，必须谨慎解释。单肺移植和双肺移植患者的生存率没有差异。单肺移植带来短期生存益处但长期危害，而双侧移植带来短期危害但长期生存益处。
Background: Patients with end-stage idiopathic pulmonary fibrosis (IPF) are increasingly having bilateral rather than single-lung transplantation.Objective: To compare survival after single and bilateral lung transplantation in patients with IPF.Design: Analysis of data from the United Network of Organ Sharing registry.Setting: Transplantation centers in the United States.Patients: 3327 patients with IPF who had single (2146 patients [64.5%]) or bilateral (1181 patients [35.5%]) lung transplantation between 1987 and 2009.Measurements: Survival times and causes of death after lung transplantation. Selection bias was accounted for by multivariate risk adjustment, propensity score risk adjustment, and propensity-based matching.Results: Median survival time was longer after bilateral lung transplantation than single-lung transplantation (5.2 years [CI, 4.3 to 6.7 years] vs. 3.8 years [CI, 3.6 to 4.1 years]; P < 0.001). However, survival times for the 2 procedures did not differ after adjustment for baseline differences, with adjusted hazard ratios (HRs) for mortality with bilateral transplantation ranging from 0.89 (95% CI, 0.79 to 1.02) to 0.96 (CI, 0.77 to 1.20) in different analyses. Bilateral lung transplantation seemed to result in harm within the first year (HR, 1.18 [CI, 0.98 to 1.42]) but survival benefit thereafter (HR, 0.72 [CI, 0.59 to 0.87]). Primary graft failure was a more common cause of death among patients who had bilateral rather than single-lung transplantation (3.7% vs. 1.9%; P = 0.002). Cancer was a more common cause of death among patients who had single rather than bilateral lung transplantation (unadjusted HR for death among single vs. bilateral transplant recipients, 3.60 [CI, 2.16 to 6.05]; P < 0.001).Limitation: Causes of death were ascertained without an adjudication committee and must be interpreted cautiously.Conclusion: Survival did not differ between patients who had single and bilateral lung transplantation. Single-lung transplantation confers short-term survival benefit but long-term harm, whereas bilateral transplantation confers short-term harm but long-term survival benefit.