Characteristics and outcomes of patients with sarcoidosis listed for lung transplantation
Characteristics and outcomes of patients with sarcoidosis listed for lung transplantation
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DOI：
10.1378/chest.120.3.873
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发表时间：
2001-09-01
期刊：
影响因子：
9.6
通讯作者：
Kotloff, RM
中科院分区：
文献类型：
--
作者：
Arcasoy, SM;Christie, JD;Kotloff, RM
研究目的：描述已列入肺移植名单的晚期结节病患者的病程，并确定在等待名单上死亡的预后因素。设计：回顾性队列研究。设置：三级护理大学医院。患者：43例已列入宾夕法尼亚大学医学中心肺移植名单的结节病患者。方法：一个多变量的解释性分析，使用考克斯比例风险模型进行，以确定与死亡率独立相关的危险因素，而患者等待transplantation.Results：23的43例（53%）死亡，而等待移植。已收载患者的生存率（通过Kaplan-Meier方法确定）为1年66%，2年40%，3年31%。在单变量分析中，以下因素与等待名单上的死亡显著相关：Pao（2）小于或等于60 mm Hg（相对风险[RR]，3.4; 95%置信区间[CI]，1.2 - 9.3）;平均肺动脉压大于或等于35 mm Hg（RR，3.2; 95% CI，1.1 - 9.5）;心脏指数小于或等于2 L/min/m2（RR，2.8; 95% CI，1.2 - 6.6），右心房压（RAP）大于或等于15 mm Hg（RR，7.6; 95% CI，3.0 - 19.3）。多变量分析显示，RAP大于或等于15 mm Hg是唯一的独立预后变量（RR，5.2; 95% CI，1.6至16.7; p = 0.006）。12例患者接受了肺移植。Kaplan-Meier法确定的移植后生存率在1年和2年均为62%，3年为50%。结论：等待肺移植的晚期结节病患者死亡率高，中位生存期< 2年。死亡率与RAP升高的关系最为密切。虽然早期转诊可能会降低等待移植的患者的死亡率，但移植后结果的进一步改善将是必要的，以确保该程序真正赋予生存益处。
Study objectives: To characterize the course of patients with advanced sarcoidosis who have been listed for lung transplantation and to identify prognostic factors for death while they are on the waiting list.Design: Retrospective cohort study.Setting: Tertiary-care university hospital.Patients: Forty-three patients with sarcoidosis who have been listed for lung transplantation at the University of Pennsylvania Medical Center.Methods: A multivariable explanatory analysis using a Cox proportional hazards model was performed to determine risk factors that are independently associated with mortality while patients await transplantation.Results: Twenty-three of the 43 patients (53%) died while awaiting transplantation. The survival rate of listed patients (as determined by the Kaplan-Meier method) was 66% at 1 year, 40% at 2 years, and 31% at 3 years. In a univariate analysis, the following factors were significantly associated with death on the waiting list: Pao(2) less than or equal to 60 mm Hg (relative risk [RR], 3.4; 95% confidence interval [CI], 1.2 to 9.3); mean pulmonary artery pressure greater than or equal to 35 mm Hg (RR, 3.2; 95% CI, 1.1 to 9.5); cardiac index less than or equal to 2 L/min/m(2) (RR, 2.8; 95% CI, 1.2 to 6.6), and right atrial pressure (RAP) greater than or equal to 15 mm Hg (RR, 7.6; 95% CI, 3.0 to 19.3). Multivariable analysis revealed that RAP greater than or equal to 15 mm Hg was the only independent prognostic variable (RR, 5.2; 95% CI, 1.6 to 16.7; p = 0.006). Twelve patients underwent lung transplantation. Survival after transplantation determined by the Kaplan-Meier method was 62% at both 1 and 2 years, and 50% at 3 years.Conclusions: Patients with advanced sarcoidosis awaiting lung transplantation have a high mortality rate with a median survival of < 2 years. Mortality is most closely linked to elevated RAP. While earlier referral may diminish the mortality rate of patients on the waiting list for transplantation, further improvements in posttransplantation outcomes will be necessary to ensure that this procedure truly bestows a survival benefit.