Güneş A, Aboyoun C L, Morton J M, Plit M, Malouf M A, Glanville A R
Thoracic Medicine, Cairns Base Hospital, Cairns, Queensland, Australia.
Intern Med J. 2006 Jan;36(1):5-11. doi: 10.1111/j.1445-5994.2006.01003.x.
Lung transplantation (LTx) offers selected patients with end-stage chronic obstructive pulmonary disease (COPD) an improved quality of life and possibly enhanced survival.
To determine local outcomes of LTx for COPD we analysed 173 consecutive heart-LTx (n = 8), single LTx (SLTx; n = 99) and bilateral LTx (BLTx; n = 66) carried out at a single institution during 1989-2003 for smoking-related emphysema (E) (n = 112) and emphysema related to alpha-1 antitrypsin deficiency (AATD) (n = 61).
There were 98 men and 75 women with a mean age of 50 +/- 6 years (standard deviation) (range 32-63 years). Median waiting time was 113 days (interquartile range (IQR) 50-230 days), and median inpatient stay was 13 days (IQR 9-21 days).
Perioperative survival (30 days) was 95% with deaths from sepsis (n = 5), cerebrovascular accident (n = 3) and multiorgan failure (n = 1). Mean follow-up period was 1693 +/- 1302 days (2-4,805 days). The 1-, 5- and 10-year survivals (%) were similar for patients with E and AATD (P = 0.480 log rank) at 86 +/- 5, 57 +/- 7 and 31 +/- 11, respectively, but 1- and 5-year survivals for E were higher after BLTx than after SLTx (97 +/- 2 and 81 +/- 8 vs 85 +/- 4 and 47 +/- 6) (P = 0.015). Pretransplant body mass index, forced expiratory volume in 1 second, forced vital capacity, PaCO(2), PaO(2), six-minute walk distance, home oxygen use, age, sex, cytomegalovirus donor-recipient mismatch, cardiopulmonary bypass use, year of transplant and ischaemic time did not influence survival after LTx. Increasing donor age was a survival risk factor for patients with E but not for those with AATD (hazard ratio 1.043; 95%confidence interval 1.014-1.025).
Survival after LTx for COPD is similar to survival for other forms of solid organ transplantation, in part reflecting risk factor management.
肺移植（LTx）为部分终末期慢性阻塞性肺疾病（COPD）患者提供了生活质量的改善以及可能延长的生存期。
为了确定COPD患者肺移植的局部疗效，我们分析了1989年至2003年在单一机构进行的173例连续性心脏肺移植（n = 8）、单肺移植（SLTx；n = 99）和双肺移植（BLTx；n = 66），这些移植针对与吸烟相关的肺气肿（E）（n = 112）和与α-1抗胰蛋白酶缺乏症（AATD）相关的肺气肿（n = 61）。
共有98名男性和75名女性，平均年龄为50±6岁（标准差）（范围32 - 63岁）。中位等待时间为113天（四分位间距（IQR）50 - 230天），中位住院时间为13天（IQR 9 - 21天）。
围手术期生存率（30天）为95%，死亡原因包括败血症（n = 5）、脑血管意外（n = 3）和多器官功能衰竭（n = 1）。平均随访期为1693±1302天（2 - 4805天）。E组和AATD组患者的1年、5年和10年生存率（%）相似（P = 0.480，对数秩检验），分别为86±5、57±7和31±11，但E组患者双肺移植后的1年和5年生存率高于单肺移植（97±2和81±8 vs 85±4和47±6）（P = 0.015）。移植前体重指数、第1秒用力呼气量、用力肺活量、PaCO₂、PaO₂、6分钟步行距离、家庭氧疗使用情况、年龄、性别、巨细胞病毒供受体错配情况、体外循环使用情况、移植年份和缺血时间均不影响肺移植后的生存率。供体年龄增加是E组患者的生存危险因素，但不是AATD组患者的生存危险因素（风险比1.043；95%置信区间1.014 - 1.025）。
COPD患者肺移植后的生存率与其他形式实体器官移植的生存率相似，部分反映了危险因素的管理情况。
