Lung transplantation for pulmonary vascular disease
Lung transplantation for pulmonary vascular disease
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DOI：
10.1016/s0003-4975(01)03082-x
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发表时间：
2002-01-01
影响因子：
4.6
通讯作者：
Patterson, GA
中科院分区：
文献类型：
--
作者：
Mendeloff, EN;Meyers, BF;Patterson, GA
背景肺动脉高压（PHT）是一种致死性疾病，导致预期寿命显著缩短。持续输注前列腺素I-2对症状管理做出了重要贡献，但它不是万能药。肺或心肺移植仍然是前列腺素I-2无效的终末期PHT患者的重要治疗选择。本研究回顾了我们项目中PHT移植后的结果。对1989年以来接受原发性PHT（48%）或继发性PHT（52%）移植的100例连续患者进行了回顾性病历审查。与活体受者联系以确认健康和功能状态。55名成人和45名儿童患者接受了51例双侧肺移植，39例单肺移植和10例心肺移植。平均年龄为23.7岁（范围：1.2个月至54.8岁），平均移植前纽约心脏协会分级为3.2。移植前血流动力学显示平均右心房压为9.6 +/- 5.4 mm Hg，平均肺动脉压为64 +/- 14.4 mm Hg。住院死亡率为17%，早期死亡主要是因为移植失败和感染。平均随访5.0年，1年和5年精算生存率分别为75%和57%。随访导管检查的平均肺动脉压为22 +/- 6.0 mm Hg，随访纽约心脏协会分级平均为1.3（与移植前相比，两者均p < 0.001）。诊断和移植类型在两组之间的生存率没有显著差异。肺或心肺移植治疗PHT的早期死亡率高于其他肺部疾病，但其长期结局相似，在生活质量和生理方面均有显著改善。(C)2002年由胸外科医师协会出版。
Background. Pulmonary hypertension (PHT) is a lethal condition resulting in markedly diminished life expectancy. Continuous prostaglandin I-2 infusion has made an important contribution to symptom management, but it is not a panacea. Lung or heart-lung transplantation remains an important treatment option for end-stage PHT patients unresponsive to prostaglandin I-2. This study reviews the outcomes after transplantation for PHT in our program.Methods. A retrospective chart review was performed for 100 consecutive patients with either primary PHT (48%) or secondary PHT (52%) transplants since 1989. Living recipients were contacted to confirm health and functional status.Results. Fifty-five adult and 45 pediatric patients underwent 51 bilateral lung transplants, 39 single lung transplants, and 10 heart-lung transplants. Mean age was 23.7 years (range, 1.2 months to 54.8 years) and mean pre-transplant New York Heart Association class was 3.2. Pre-transplant hemodynamics revealed a mean right atrial pressure of 9.6 +/- 5.4 mm Hg and mean pulmonary artery pressure of 64 +/- 14.4 mm. Hg. Hospital mortality was 17% with early death predominantly because of graft failure and infection. With an average follow-up of 5.0 years, 1- and 5-year actuarial survival was 75% and 57%, respectively. Mean pulmonary artery pressure on follow-up catheterization was 22 +/- 6.0 mm Hg, and mean follow-up New York Heart Association class was 1.3 (p < 0.001 for both compared with pre-transplant). Diagnosis and type of transplant did not confer a significant difference in survival between groups.Conclusions. Whereas lung or heart-lung transplant for PHT is associated with higher early mortality than other pulmonary disease entities, it provides similar long-term outcomes with dramatic improvement in both quality of life and physiologic aspects. (C) 2002 by The Society of Thoracic Surgeons.