使用50岁及以上供体的肺进行肺移植。
Lung transplantation with lungs from donors fifty years of age and older.
作者信息
Fischer Stefan, Gohrbandt Bernhard, Struckmeier Pascal, Niedermeyer Jost, Simon Andre, Hagl Christian, Kallenbach Klaus, Haverich Axel, Strüber Martin
机构信息
Hannover Thoracic Transplant Program, Division of Thoracic- and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
出版信息
J Thorac Cardiovasc Surg. 2005 Apr;129(4):919-25. doi: 10.1016/j.jtcvs.2004.07.053.
BACKGROUND
A shortage of donors has led to the progressive expansion of criteria for donor selection in lung transplantation. The outcome of recipients of lungs from donors aged 50 years or older is analyzed systematically.
METHODS
From March 1998 to June 2003, 49 recipients received lungs from donors aged 50 years or older (range 50-64 years, mean 54 +/- 3 years). This group of recipients was compared with 244 patients receiving lungs from donors aged less than 50 years (range 7-49 years, mean 32 +/- 11 years). This study was undertaken on all 293 patients at our institution who received Perfadex-preserved lungs (Vitrolife, Goteborg, Sweden).
RESULTS
Recipient age, sex, and indications for transplant did not differ significantly between groups. Also, the percentage of the different types of transplants (bilateral or single lung transplantation) performed was equal in both cohorts. Donor Pa(O2) /F(IO2) ratios before lung retrieval (415 +/- 91 vs 439 +/- 113, respectively) and length of ischemic time (347 +/- 67 minutes vs 351 +/- 84 minutes, respectively) did not differ significantly between the older and younger donor groups. The following posttransplant parameters were also not statistically different: first Pa(O2)/F(IO2) at intensive care unit arrival (274 +/- 125 in the older donor group vs 253 +/- 119 in the younger donor group, respectively), mechanical ventilation time (328 +/- 427 hours vs 269 +/- 425 hours, respectively), and length of stay in the intensive care unit (16 +/- 18 days vs 14 +/- 18 days, respectively). Recipient survival in the older and younger donor groups at 30 days, 3, 6, 12, 24, and 60 months was 77% +/- 6%, 75% +/- 6%, 73% +/- 7%, 73% +/- 7%, 68% +/- 5%, and 68% +/- 4% versus 86% +/- 2%, 83% +/- 3%, 80% +/- 3%, 78% +/- 3%, 71% +/- 4%, and 66% +/- 4%, respectively.
CONCLUSIONS
Lung grafts from elderly donors have been considered as marginal organs for transplantation. However, this study indicates that transplantation of lungs from carefully selected donors aged 50 years or more may lead to similar short- and long-term outcomes compared with lungs from younger donors. The use of lungs from elderly donors may help to increase the number of donor organs in lung transplantation.
背景
供体短缺导致肺移植供体选择标准逐渐放宽。本研究系统分析了年龄在50岁及以上供体的肺移植受者的预后情况。
方法
1998年3月至2003年6月，49例受者接受了年龄在50岁及以上供体的肺移植（年龄范围50 - 64岁，平均54±3岁）。将这组受者与244例接受年龄小于50岁供体肺移植的患者（年龄范围7 - 49岁，平均32±11岁）进行比较。本研究纳入了我院所有293例接受Perfadex保存肺（Vitrolife，瑞典哥德堡）的患者。
结果
两组受者的年龄、性别和移植指征无显著差异。此外，两组进行的不同类型移植（双侧或单肺移植）的比例相同。老年和年轻供体组在肺获取前的供体动脉血氧分压/吸入氧分数值（分别为415±91和439±113）以及缺血时间（分别为347±67分钟和351±84分钟）无显著差异。以下移植后参数也无统计学差异：入住重症监护病房时的首次动脉血氧分压/吸入氧分数值（老年供体组为274±125，年轻供体组为253±119）、机械通气时间（分别为328±427小时和269±425小时）以及在重症监护病房的住院时间（分别为16±18天和14±18天）。老年和年轻供体组受者在30天、3个月、6个月、12个月、24个月和60个月时的生存率分别为77%±6%、75%±6%、73%±7%、73%±7%、68%±5%和68%±4%，而年轻供体组分别为86%±2%、83%±3%、80%±3%、78%±3%、71%±4%和66%±4%。
结论
老年供体的肺移植一直被视为边缘性移植器官。然而，本研究表明，与年轻供体的肺相比，精心挑选的50岁及以上供体的肺移植可能会带来相似的短期和长期预后。使用老年供体的肺可能有助于增加肺移植中供体器官的数量。
Zotero 插件