Shorr Andrew F, Helman Donald L, Davies Darcy B, Nathan Steven D
Pulmonary & Critical Care Medicine Service, Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Chest. 2004 Mar;125(3):990-6. doi: 10.1378/chest.125.3.990.
Patients with sarcoidosis, many of whom are African American, may require lung transplantation (LT). Little is known about survival following LT for sarcoidosis.
To determine short-term mortality following LT for sarcoidosis, to evaluate if survival after LT for sarcoidosis is similar to outcomes after LT for other diseases, and to investigate the impact of race on the results of LT.
Retrospective review.
All patients who underwent LT, irrespective of diagnosis, in the United States between January 1995 and December 2000.
Vital status at 30 days after LT and cause of death.
During the study period, 4,721 LTs were performed; of these 133 LTs (2.8%) were for sarcoidosis. Approximately 83% of patients with sarcoidosis survived following LT compared to 91% of persons undergoing transplantation for other reasons (p = 0.002). In multivariate analysis controlling both for health insurance status and other factors known to affect survival after LT, patients with sarcoidosis were no more likely to die than persons undergoing transplantation for other conditions (adjusted odds ratio for death, 1.45; 95% confidence interval [CI], 0.84 to 2.48). Significant predictors of mortality included the following: undergoing combined heart-lung transplant, need for mechanical ventilation, treatment in an ICU at time of LT, pre-LT FEV(1), need for supplemental oxygen, and donor age. Both recipient race and donor race significantly affected short-term survival. African-American patients were nearly 50% more likely to die (adjusted odds ratio, 1.49; 95% CI, 1.01 to 2.20). This difference based on race persisted after excluding heart-lung recipients and after controlling for recipient-donor racial mismatch. The most frequent cause of death for patients with sarcoidosis was graft failure, while infection was the primary cause of death among other LT patients.
Patients with sarcoidosis do as well as patients undergoing LT for other diseases. Race is an important factor affecting survival after LT.
结节病患者（其中许多是非裔美国人）可能需要进行肺移植（LT）。关于结节病肺移植后的生存率知之甚少。
确定结节病肺移植后的短期死亡率，评估结节病肺移植后的生存率是否与其他疾病肺移植后的结果相似，并调查种族对肺移植结果的影响。
回顾性研究。
1995年1月至2000年12月期间在美国接受肺移植的所有患者，无论诊断如何。
肺移植后30天的生命状态和死亡原因。
在研究期间，共进行了4721例肺移植；其中133例（2.8%）是用于治疗结节病。结节病患者肺移植后约83%存活，而因其他原因接受移植的患者这一比例为91%（p = 0.002）。在多变量分析中，控制医疗保险状况和其他已知影响肺移植后生存的因素后，结节病患者死亡的可能性并不高于因其他疾病接受移植的患者（调整后的死亡比值比为1.45；95%置信区间[CI]，0.84至2.48）。死亡率的显著预测因素包括以下几点：接受心肺联合移植、需要机械通气、肺移植时在重症监护病房接受治疗、肺移植前的第一秒用力呼气量（FEV(1)）、需要补充氧气以及供体年龄。受者种族和供体种族均显著影响短期生存。非裔美国患者死亡的可能性几乎高出50%（调整后的比值比为1.49；95%CI，1.01至2.20）。排除心肺移植受者并控制受者 - 供体种族不匹配后，基于种族的差异仍然存在。结节病患者最常见的死亡原因是移植物衰竭，而感染是其他肺移植患者的主要死亡原因。
结节病患者肺移植后的情况与因其他疾病接受肺移植的患者相同。种族是影响肺移植后生存的一个重要因素。
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