Survival After Single Versus Bilateral Lung Transplantation for High-Risk Patients With Pulmonary Fibrosis
Survival After Single Versus Bilateral Lung Transplantation for High-Risk Patients With Pulmonary Fibrosis
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DOI：
10.1016/j.athoracsur.2009.06.044
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发表时间：
2009-11-01
影响因子：
4.6
通讯作者：
Shah, Ashish S.
中科院分区：
文献类型：
--
作者：
Weiss, Eric S.;Allen, Jeremiah G.;Shah, Ashish S.
背景对于重度特发性肺纤维化（IPF）患者，单肺移植（CABG）或双侧肺移植（BLT）是否是最佳选择尚不清楚。我们研究了一个大型的多机构高风险IPF患者队列来解决这个问题。我们回顾性分析了器官共享联合网络的数据，以确定2005年至2007年期间1，256例肺移植（LTx）受者的IPF。在肺分配评分水平（LAS [均连续纳入相互作用项并按LAS四分位数分类]）中检查了肺移植与BLT的30天、90天和1年死亡率风险。多因素分析采用考克斯比例风险回归。肺分配评分四分位数如下：四分位数1，29.8 - 37.8，n = 315;四分位数2，37.9 - 42.4，n = 313;四分位数3，42.5 - 51.9，n = 314;四分位数4，52.0 - 94.1，n = 314。总体而言，最高LAS四分位数（59.5%）接受BLT的患者比最低LAS四分位数（38.4%，p < 0.05）多21.1%。在最高风险患者中，BLT与LTx后1年死亡率降低14.4%相关。单变量分析（风险比1.90 [95%置信区间：1.16至3.13]，p = 0.01）和多变量分析（风险比2.09 [95%置信区间：1.07至4.10]，p = 0.03）以及纳入肺动脉高压和最大随访的敏感性分析证实了这种生存获益。在未校正或多变量校正分析中，在任何四分位数中，LTx后30或90天的死亡风险均无差异。我们提供了一个初步的检查生存的程序类型和LAS评分的LTx接受者与IPF。对于高风险患者，双侧LTx似乎比双单侧LTx具有优势。
Background. Whether single lung transplantation (SLT) or bilateral lung transplantation (BLT) is optimal for patients with severe idiopathic pulmonary fibrosis (IPF) is unknown. We examine a large multi-institutional cohort of high-risk IPF patients to address this question.Methods. We retrospectively reviewed United Network for Organ Sharing data to identify 1,256 lung transplant (LTx) recipients with IPF between 2005 and 2007. Risk of 30-day, 90-day, and 1-year mortality for SLT versus BLT was examined across levels of the lung allocation score (LAS [both continuous with incorporation of interaction terms and categorized by LAS quartiles]). Multivariable analysis was conducted through Cox proportional hazards regression.Results. Lung allocation score quartiles were as follows: quartile 1, 29.8 to 37.8, n = 315; quartile 2, 37.9 to 42.4, n = 313; quartile 3, 42.5 to 51.9, n = 314; and quartile 4, 52.0 to 94.1, n = 314. Overall, 21.1% more patients received BLT in the highest LAS quartile (59.5%) than in the lowest LAS quartile (38.4%, p < 0.05). In patients at highest risk, BLT was associated with a 14.4% decrease in mortality at 1 year after LTx. This survival benefit was confirmed on univariate analysis (hazard ratio 1.90 [95% confidence interval: 1.16 to 3.13], p = 0.01) and multivariable analysis (hazard ratio 2.09 [95% confidence interval: 1.07 to 4.10], p = 0.03) as well as in sensitivity analyses incorporating pulmonary hypertension and maximizing follow-up. There were no differences in the risk of death with SLT at 30 or 90 days after LTx in any quartile on unadjusted or multivariable adjusted analysis.Conclusions. We provide an initial examination of survival by procedure type and LAS score for LTx recipients with IPF. Bilateral LTx appears to offer advantages over SLT for high-risk patients.