Botha Phil, Trivedi Dipesh, Weir Christopher J, Searl Cait P, Corris Paul A, Dark John H, Schueler Stephan V B
Department of Cardio-pulmonary Transplantation, Freeman Hospital, High Heaton, Newcastle upon Tyne, United Kingdom.
J Thorac Cardiovasc Surg. 2006 May;131(5):1154-60. doi: 10.1016/j.jtcvs.2005.12.037.
Some reports have documented a higher early mortality with the use of extended criteria donors in lung transplantation. None have evaluated how outcomes compare with the use of these organs for single and bilateral transplantation or whether this practice results in a higher incidence of early bronchiolitis obliterans syndrome.
We performed a retrospective review of case notes, intensive therapy unit database, and donor details. Between January 1, 2000, and December 31, 2004, 201 patients underwent lung or heart-lung transplantation.
Eighty-three (41.3%) patients received organs deemed marginal on the basis of at least one of the following criteria: donor age greater than 55 years, duration of ventilation greater than 5 days, purulent secretions or inflammation at bronchoscopy, smoking of 20 or more cigarettes per day, abnormality on chest roentgenogram, or PO2/fraction of inspired oxygen ratio of less than 300 mm Hg immediately before donor organ procurement. Recipients of marginal lungs had a higher incidence of severe (grade 3) primary graft dysfunction (43.9% vs 27.4%, P = .015) and 90-day organ-specific mortality (15.7% vs 5.1%, P = .012). Bilateral transplantation carried a significantly higher 30-day mortality if performed with marginal organs (17.0% vs 2.7% with standard donor organs, P = .005). Thirty-day mortality was not significantly different for the transplantation of single marginal or standard donor lungs. Cumulative survival and survival free of bronchiolitis obliterans syndrome was not affected by marginal donor status.
Transplantation of extended criteria donor lungs leads to a higher incidence of primary graft dysfunction. Bilateral transplantation with these organs seems to confer less reserve, resulting in a higher early mortality rate. Medium-term functional outcome is, however, not adversely affected by the relaxation of donor criteria.
一些报告记录了在肺移植中使用扩大标准供体时早期死亡率较高的情况。但尚无研究评估使用这些器官进行单肺和双肺移植的结果对比情况，也没有研究评估这种做法是否会导致早期闭塞性细支气管炎综合征的发生率更高。
我们对病例记录、重症监护病房数据库和供体详细信息进行了回顾性分析。在2000年1月1日至2004年12月31日期间，201例患者接受了肺或心肺移植。
83例（41.3%）患者接受了基于以下至少一项标准被视为边缘性的器官：供体年龄大于55岁、通气时间大于5天、支气管镜检查时有脓性分泌物或炎症、每天吸烟20支或更多、胸部X线片异常，或在获取供体器官前即刻动脉血氧分压/吸入氧分数比小于300mmHg。边缘性肺的受者严重（3级）原发性移植功能障碍的发生率更高（43.9%对27.4%，P = 0.015），90天器官特异性死亡率更高（15.7%对5.1%，P = 0.012）。如果使用边缘性器官进行双肺移植，其30天死亡率显著更高（17.0%对使用标准供体器官时的2.7%，P = 0.005）。单肺边缘性供体或标准供体肺移植的30天死亡率无显著差异。累积生存率和无闭塞性细支气管炎综合征生存率不受边缘性供体状态的影响。
扩大标准供体肺移植会导致原发性移植功能障碍的发生率更高。使用这些器官进行双肺移植似乎储备更少，导致早期死亡率更高。然而，中期功能结果不受供体标准放宽的不利影响。
