Ruttmann Elfriede, Ulmer Hanno, Marchese Martina, Dunst Karin, Geltner Christian, Margreiter Raimund, Laufer Guenther, Mueller Ludwig C
Department of Cardiac Surgery, University of Innsbruck, Innsbruck, Austria.
J Heart Lung Transplant. 2005 Mar;24(3):275-81. doi: 10.1016/j.healun.2004.01.008.
Lung transplantation has become important in treating end-stage lung disease; however, bronchial complications are common. Lack of bronchial arterial circulation, ischemic time, and acute rejection episodes may damage the bronchial wall. In this study, we analyzed factors that may hamper bronchial airway healing, requiring intervention after lung transplantation.
We collected data from a consecutive series of 81 transplantations performed between 1993 and 2002 and evaluated recipients for bronchial complications. In 30 single and 51 sequential bilateral lung transplantations, a total of 132 anastomoses were performed. Four patients (3 bilateral and 1 single lung transplant recipients who died within the first 14 post-operative days were excluded from the analysis. Finally, 125 lung grafts remained for statistical analysis of factors influencing bronchial complications.
Peri-operative mortality was 8.9%. Eleven patients (14.7%) experienced severe bronchial complications in 16 of 125 evaluated bronchial anastomoses (12.8%) and required surgical treatment or bronchoscopic interventional therapy. In a multivariate logistic regression model, severe reperfusion edema (adjusted odds ratio, 8.3; p = 0.002) and rejection episode within the 1st post-operative month (adjusted odds ratio, 4.1; p = 0.036) were associated with bronchial complications. Using the univariate model, we found that factors such as interleukin-2-antibody induction therapy, immunosuppression, or bronchial anastomotic technique had significant influence on bronchial healing, whereas we could not confirm this when using multivariate anasysis.
Preventing reperfusion edema with optimized lung preservation and with early and aggressive medical treatment or mechanical hemodynamical support (e.g., veno-arterial extra corporal membrane oxygenation are necessary to avoid prolonged ventilation dependence, which may result in bronchial complications. Furthermore, avoiding early rejection episodes promotes uncomplicated bronchial healing.
肺移植已成为治疗终末期肺病的重要手段；然而，支气管并发症很常见。支气管动脉循环缺失、缺血时间以及急性排斥反应可能会损害支气管壁。在本研究中，我们分析了可能阻碍支气管气道愈合、需要在肺移植后进行干预的因素。
我们收集了1993年至2002年间连续进行的81例移植手术的数据，并对受者的支气管并发症进行评估。在30例单肺移植和51例序贯双侧肺移植中，共进行了132次吻合。4例患者（3例双侧肺移植和1例单肺移植受者在术后前14天内死亡）被排除在分析之外。最后，125个肺移植用于影响支气管并发症因素的统计分析。
围手术期死亡率为8.9%。11例患者（14.7%）在125个评估的支气管吻合口中的16个（12.8%）出现严重支气管并发症，需要手术治疗或支气管镜介入治疗。在多因素逻辑回归模型中，严重再灌注水肿（调整优势比，8.3；p = 0.002）和术后第1个月内的排斥反应（调整优势比，4.1；p = 0.036）与支气管并发症相关。使用单因素模型时，我们发现白细胞介素-2抗体诱导治疗、免疫抑制或支气管吻合技术等因素对支气管愈合有显著影响，而在多因素分析时我们无法证实这一点。
通过优化肺保存、早期积极的药物治疗或机械血流动力学支持（如静脉-动脉体外膜肺氧合）预防再灌注水肿，对于避免可能导致支气管并发症的长期通气依赖是必要的。此外，避免早期排斥反应可促进支气管顺利愈合。
