Risk factors for airway complications within the first year after lung transplantation
Risk factors for airway complications within the first year after lung transplantation
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DOI：
10.1016/j.ejcts.2007.01.025
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发表时间：
2007-04-01
影响因子：
3.4
通讯作者：
Lerut, Toni
中科院分区：
文献类型：
--
作者：
De Wauwer, Caroline Van;Van Raemdonck, Dirk;Lerut, Toni
目的：近年来，肺移植（LTx）的成功率和生存率不断提高。然而，气道吻合并发症（AC）仍然是早期发病率和死亡率的潜在原因。在这项回顾性队列研究中，我们研究了LTx后第一年内AC的可能预测因素。研究方法：在1991年7月至2004年12月期间，进行了232例连续单（n = 102）和双侧（n = 130）LTx（142例雄性和90例雌性;平均年龄：48岁[范围15-66岁]）。LTx的适应症为肺气肿（n = 113）、肺纤维化（n = 45）、囊性纤维化（n = 35）、肺动脉高压（n = 10）、结节病（n = 7）和其他（n = 22）。在单变量和多变量模型中评价供体变量（年龄、性别、PaO 2/FiO（2）、机械通气、缺血时间和保存溶液）和受体变量（年龄、诊断、身高、性别、术前类固醇、吸烟、巨细胞病毒匹配、LTx类型、吻合口类型、包裹和旁路）。结果：362例患者中发生并发症57例（15.7%），其中55例（15.2%）发生在术后1年内。6例患者在LTx后第一年死于AC（死亡率2.6%）。在一项单变量分析中（321例存在气道狭窄风险），吻合类型（7/17 [伸缩式] vs 48/304 [端对端]; p = 0.011）、受体长度（p = 0.0012）、供体通气（>50-70 h
Objective: Lung transplantation (LTx) has enjoyed increasing success with better survival in recent years. Nevertheless, airway anastomotic complications (AC) are still a potential cause of early morbidity and mortality. In this retrospective cohort study we looked at possible predictors of AC within the first year after LTx. Methods: Between July 1991 and December 2004, 232 consecutive single (n = 102) and bilateral (n = 130) LTx were performed (142 mates and 90 females; mean age: 48 years [range 15-66 years]). Indications for LTx were emphysema In = 113), pulmonary fibrosis (n = 45), cystic fibrosis (n = 35), pulmonary hypertension (n = 10), sarcoidosis (n = 7) and miscellaneous (n = 22). Donor variables (age, gender, PaO2/FiO(2), mechanical ventilation, ischemic time and preservation solution) and recipient variables (age, diagnosis, length, gender, pre-operative steroids, smoking, cytomegalovirus matching, LTx type, anastomotic type, wrapping and bypass) were evaluated in an univariate and multivariate model. Results: Fifty-seven complications occurred in 362 airway anastomoses (15.7%) of which 55 (15.2%) within the first year after transplantation. Six patients died as a result of AC (mortality 2.6%) during the first year after LTx. In a univariate analysis (321 airway anastomoses at risk), anastomotic type (7/17 [Telescoping] vs 48/304 [End-to-end]; p = 0.011), recipient length (p = 0.0012), donor ventilation (>50-70 h