Thabut Gabriel, Ravaud Philippe, Christie Jason D, Castier Yves, Fournier Michel, Mal Hervé, Lesèche Guy, Porcher Raphaël
Service de Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France.
Am J Respir Crit Care Med. 2008 May 15;177(10):1156-63. doi: 10.1164/rccm.200708-1283OC. Epub 2008 Feb 28.
Although chronic obstructive pulmonary disease is the first indication for lung transplantation, the benefit of the procedure in terms of survival remains debated.
To estimate the determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease.
Using information from the United Network for Organ Sharing database on 8,182 patients, we developed an approach based on numerical simulations to estimate the survival effect of lung transplantation.
The main outcome measure was the difference between median survival with transplantation and that without transplantation measured from time of transplant list registration. Survival benefit was greater with double than with single lung transplantation (mean difference, 307 d [95% confidence interval, 217-523]). With double lung transplantation, 44.6% of patients would gain 1 year or more, 29.4% would gain or lose less than 1 year, and 26% would lose 1 year or more. Major determinants of the survival effect of transplantation were systolic pulmonary artery pressure, FEV(1), body mass index, exercise capacity, functional status, and the need for continuous mechanical ventilation or oxygen. For instance, 79% of patients with an FEV(1) less than 16% of the predicted value would gain 1 year or more with double lung transplantation as compared with only 11% of patients with an FEV(1) of more than 25%.
We identified several factors associated with the survival benefit of lung transplantation. External validation of our models is required before translating these results into clinical practice.
尽管慢性阻塞性肺疾病是肺移植的首要指征，但该手术在生存获益方面仍存在争议。
评估慢性阻塞性肺疾病患者肺移植生存获益的决定因素。
利用器官共享联合网络数据库中8182例患者的信息，我们开发了一种基于数值模拟的方法来评估肺移植的生存效果。
主要结局指标是从列入移植名单登记时间起测量的移植后与未移植的中位生存期差异。双肺移植的生存获益大于单肺移植（平均差异为307天[95%置信区间为217 - 523]）。接受双肺移植的患者中，44.6%将多活1年或更长时间，29.4%的患者生存期增减不到1年，26%的患者将少活1年或更长时间。移植生存效果的主要决定因素是收缩期肺动脉压、第1秒用力呼气容积（FEV₁）、体重指数、运动能力、功能状态以及是否需要持续机械通气或吸氧。例如，FEV₁低于预测值16%的患者中，79%接受双肺移植后将多活1年或更长时间，而FEV₁超过25%的患者中这一比例仅为11%。
我们确定了几个与肺移植生存获益相关的因素。在将这些结果应用于临床实践之前，需要对我们的模型进行外部验证。
