Lung Size Mismatch and Survival After Single and Bilateral Lung Transplantation
Lung Size Mismatch and Survival After Single and Bilateral Lung Transplantation
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DOI：
10.1016/j.athoracsur.2013.04.064
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发表时间：
2013-08-01
影响因子：
4.6
通讯作者：
Merlo, Christian A.
中科院分区：
文献类型：
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作者：
Eberlein, Michael;Reed, Robert M.;Merlo, Christian A.
背景较高的预测总肺容量（pTLC）比率（=pTLC供体/pTLC受体）提示过大的同种异体移植物，与肺移植后存活率的改善相关。目前尚不清楚pTLC比率与双侧（BLT）和单肺移植（BLT）的存活率是否有不同的相关性。计算2005年5月至2010年4月期间器官共享肺移植联合网络（LTx）登记研究中在肺分配评分后首次接受LTx的所有成人患者的pTLC比率。LTx接受者根据手术进行分层（BLT vs ELT）。采用Kaplan-Meier生存率和考克斯比例风险模型分析LTx后1年的死亡风险。在4,520例BLT患者中，在单变量分析中，pTLC比值每增加0.1，1年死亡风险降低7%（p < 0.001）。在控制了诊断、合并症、急性、供体和移植因素后，这种相关性仍然显著（风险比[HR] 0.93，95%置信区间[CI] 0.88至0.98，p = 0.01）。通过倾向评分进行额外调整以解释尺寸过大偏倚，结果相似（HR 0.94，95% CI 0.90 - 0.99，p = 0.018）。在2，477例COPD患者中，在单变量分析中，pTLC比值每增加0.1，1年死亡风险降低6%（p = 0.002），在多变量模型中，这一结果并不持久（HR 1.00，p = 0.8）。较高的pTLC比率，提示过大的同种异体移植物，与肺移植后存活率的提高相关。这种关联主要在BLT患者中明显。(C)2013年由胸外科医师协会
Background. A higher predicted total lung capacity (pTLC)-ratio (=pTLC donor/pTLC recipient), suggestive of oversized allografts, is associated with improved survival after lung transplantation. It is unknown whether the pTLC-ratio has a different association with survival in bilateral (BLT) versus single lung transplantation (SLT).Methods. The pTLC-ratio was calculated for all adult patients in the United Network of Organ Sharing lung transplant (LTx) registry who underwent first-time LTx in the post lung allocation score era, between May 2005 and April 2010. The LTx recipients were stratified according to procedure (BLT vs SLT). Risk of death at 1 year after LTx was analyzed using Kaplan-Meier survival and Cox proportional hazards models.Results. In the 4,520 BLT patients, each 0.1 increase in pTLC-ratio conferred a 7% decrease in the hazard for death at 1 year (p < 0.001) in univariate analysis. This association remained significant after controlling for diagnosis, comorbidities, acuity, donor, and transplant factors (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.88 to 0.98, p = 0.01). Additional adjustment by a propensity score to account for biases to oversizing showed similar results (HR 0.94, 95% CI 0.90 to 0.99, p = 0.018). In the 2,477 SLT patients, each 0.1 increase in pTLC-ratio conveyed a 6% decrease in the hazard for death at 1 year (p = 0.002) in univariate analysis, which did not persist in the multivariate model (HR 1.00, p = 0.8).Conclusions. A higher pTLC-ratio, suggestive of an oversized allograft, is associated with improved survival after lung transplantation. This association is primarily evident in BLT patients. (C) 2013 by The Society of Thoracic Surgeons