Single-lung transplantation: does side matter?
Single-lung transplantation: does side matter?
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DOI：
10.1016/j.ejcts.2011.03.011
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发表时间：
2011-08-01
影响因子：
3.4
通讯作者：
Van Raemdonck, Dirk
中科院分区：
文献类型：
--
作者：
Tsagkaropoulos, Sokratis;Belmans, Ann;Van Raemdonck, Dirk
目的：单肺移植（SLTx）是治疗非化脓性终末期肺病的有效方法。这一战略有助于克服目前的器官短缺问题。通常根据移植前定量灌注扫描选择侧，除非特定受体考虑或对侧肺提供指示对侧。左（L）与右（R）SLTx之间的结局是否存在差异仍在很大程度上未知。研究方法：在1991年7月至2009年7月期间，对142例死亡供体（M/F = 81/61;年龄= 40（14-66）岁）进行了142例首次SLTx（M/F = 87/55;年龄= 59（29-69）岁），中位随访时间为32（0-202）个月。SLTx的适应症为肺气肿（55.6%）、肺纤维化（36.6%）、原发性肺动脉高压（0.7%）和其他（7.0%）。比较L-SLTx（n = 72）和R-SLTx（n = 70）的受体的供体和受体特征以及早期和晚期结局。结果：L-SLTx的供体更年轻（37（14-65）vs 43（16-66）岁; p = 0.033）。R-SLTx受体更常发生肺气肿（67.1% vs 44.4%; p = 0.046）和置换自体肺，灌注>= 50%（47.1% vs 23.6%; p = 0.003）。两组之间的转流需要、拔管时间、重症监护室（ICU）和住院时间以及30天死亡率没有差异。1年、3年和5年的总生存率分别为78.4%、60.5%和49.4%，中位生存期为60个月，两侧之间无显著差异。第一秒用力呼气量（FEV（1））在36个月时，两组均改善（p < 0.01）至相当值。L-SLTx与R-SLTx治疗后的总体并发症（44.4% vs 50.0%）或同种异体移植物并发症（25.0% vs 24.3.0%）以及至闭塞性细支气管炎综合征（BOS）的时间（35个月）和5年无BOS的时间（68.9% vs 75.0%）分别相当。所有死亡原因均无差异（p = 0.766）。在多变量分析中，BOS是生存率的一个强有力的负向预测因子（风险比（HR）6.78; p < 0.001），而灌注侧和不匹配则不是。结论：SLTx的首选侧在纤维化与肺气肿受者之间存在差异。SLTx后移植侧不影响受体存活率、无BOS、并发症或肺功能。除了接受者的手术考虑外，提供与首选侧相反的供体肺不应成为推迟移植的理由，直到找到更匹配的供体。（C）2011年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: Single-lung transplantation (SLTx) is a valid treatment option for patients with non-suppurative end-stage pulmonary disease. This strategy helps to overcome current organ shortage. Side is usually chosen based on pre-transplant quantitative perfusion scan, unless specific recipient considerations or contralateral lung offer dictates opposite side. It remains largely unknown whether outcome differs between left (L) versus right (R) SLTx. Methods: Between July 1991 and July 2009, 142 first SLTx (M/F = 87/55; age = 59 (29-69) years) were performed from 142 deceased donors (M/F = 81/61; age = 40 (14-66) years) with a median follow-up of 32 (0-202) months. Indications for SLTx were emphysema (55.6%), pulmonary fibrosis (36.6%), primary pulmonary hypertension (0.7%), and others (7.0%). Recipients of L-SLTx (n = 72) and R-SLTx (n = 70) were compared for donor and recipient characteristics and for early and late outcome. Results: Donors of L-SLTx were younger (37 (14-65) vs 43 (16-66) years; p = 0.033). R-SLTx recipients had more often emphysema (67.1% vs 44.4%; p = 0.046) and replacement of native lung with >= 50% perfusion (47.1% vs 23.6%; p = 0.003). The need for bypass, time to extubation, intensive care unit (ICU) and hospital stay, and 30-day mortality did not differ between groups. Overall survival at 1, 3, and 5 years was 78.4%, 60.5%, and 49.4%, respectively, with a median survival of 60 months, with no significant differences between sides. Forced expiratory volume in 1 s (FEV(1)) improved (p < 0.01) in both groups to comparable values up to 36 months. Complications overall (44.4% vs 50.0%) or in allograft (25.0% vs 24.3.0%) as well as time to bronchiolitis obliterans syndrome (BOS) (35 months) and 5-year freedom from BOS (68.9% vs 75.0%) were comparable after L-SLTx versus R-SLTx, respectively. There were no differences in all causes of death (p = 0.766). On multivariate analysis, BOS was a strong negative predictor for survival (hazard ratio (HR) 6.78; p < 0.001), whereas side and mismatch for perfusion were not. Conclusion: The preferred side for SLTx differed between fibrotic versus emphysema recipients. Transplant side does not influence recipient survival, freedom from BOS, complications, or pulmonary function after SLTx. Besides surgical considerations in the recipient, offer of a donor lung opposite to the preferred side should not be a reason to postpone the transplantation until a better-matched donor is found. (C) 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.