Lindsey J D, Wigfield C H, Nath D S, Anderson J E, Leverson G E, Love R B
University of Wisconsin Hospitals, Madison, Wisconsin 53705, USA.
Transplant Proc. 2006 Dec;38(10):3685-8. doi: 10.1016/j.transproceed.2006.10.178.
It remains unclear which donor and recipient factors influence long-term allograft function in lung transplantation (LTx).
From October 1988 to February 2005, a total of 280 recipients underwent LTx at our center. Donor data and cause of death (CoD) were analyzed. The CoD was categorized according to rate of increase in intracranial pressure at the time of death. Each donor and recipient factor was correlated with long-term graft function. Recipient details, type of transplant, indication for transplant, and time on waiting list were analyzed. Recipients were stratified based on allograft ischemia time (AIT): 0 to 6, 6 to 8, 8 to 10, and >10 hours.
Mean donor age was 30.9 years (36.7% male); 49.8% were cytomegalovirus (CMV) positive. Donor CoD was characterized by a slow rise in intracranial pressure (ICP) in 34.4%, rapid ICP in 18.7%, an intermediate ICP in 44.3%, and with no rise in 2.6%. A graft survival benefit was seen with female donors (P = .048); 34.4% of recipients ultimately developed graft failure at long term follow-up. Mean recipient age was 48 years; 63% were male and mean body-mass index (BMI) was 23.6; 60.2% had single lung transplantation, and mean wait list time was 323 days. Mean AIT totaled 421 minutes. Graft survival was longer with AIT of 8 to 10 hours compared to 6 to 8 hours (P = .03).
Donor factor analysis implied only female donor status conferred a long-term graft survival advantage. Intracranial pressure rise differences appear clinically unimportant. Prolonged cold ischemic time (>10 hours) or low recipient BMI did not adversely affect allograft function in our review.
目前尚不清楚哪些供体和受体因素会影响肺移植（LTx）中长期移植肺功能。
1988年10月至2005年2月，共有280例受体在我们中心接受了肺移植。对供体数据和死亡原因（CoD）进行了分析。死亡原因根据死亡时颅内压升高的速率进行分类。将每个供体和受体因素与长期移植肺功能进行关联分析。对受体的详细信息、移植类型、移植指征以及等待名单上的时间进行了分析。根据移植肺缺血时间（AIT）将受体分层为：0至6小时、6至8小时、8至10小时以及>10小时。
供体平均年龄为30.9岁（男性占36.7%）；49.8%为巨细胞病毒（CMV）阳性。供体死亡原因的特征为：颅内压（ICP）缓慢升高的占34.4%，ICP快速升高的占18.7%，ICP中等升高的占44.3%，无升高的占2.6%。女性供体的移植肺存活情况有优势（P = 0.048）；34.4%的受体在长期随访中最终出现移植肺功能衰竭。受体平均年龄为48岁；男性占63%，平均体重指数（BMI）为23.6；60.2%接受了单肺移植，平均等待名单时间为323天。AIT平均总计421分钟。与6至8小时相比，AIT为8至10小时时移植肺存活时间更长（P = 0.03）。
供体因素分析表明只有女性供体状态赋予长期移植肺存活优势。颅内压升高差异在临床上似乎并不重要。在我们的综述中，延长的冷缺血时间（>10小时）或受体低BMI并未对移植肺功能产生不利影响。
