Gómez-Caro Abel, Martinez Elisabeth, Rodríguez Alberto, Sanchez David, Martorell Jaume, Gimferrer Josep Maria, Haverich Axel, Harringer Wolfgang, Pomar Jose Louis, Macchiarini Paolo
Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Ann Thorac Surg. 2008 Dec;86(6):1753-61; discussion 1761. doi: 10.1016/j.athoracsur.2008.06.027.
The purpose of this study was to evaluate the long-term clinical and immunologic outcome of cryopreserved arterial allograft (CAA) revascularization of intrathoracic vessels invaded by malignancies.
Since January 2002, consecutive patients whose intrathoracic vessels were invaded by malignancies were operated on and revascularizion made using human lymphocyte antigen (HLA)- and ABO-mismatched CAAs. Immunologic studies were performed preoperatively, and 1, 3, 6, 12, and 24 months postoperatively. Postoperative oral anticoagulation therapy was not given.
Twenty-six patients aged 53.1 +/- 15 years with a nonsmall-cell lung cancer (n = 10), invasive mediastinal tumors (n = 7), pulmonary artery sarcoma (n = 3), laryngeal (n = 2), or other rare lung neoplasms (n = 4) underwent operation. Cardiopulmonary bypass was used in 10 cases (38%), and all resections were pathologically complete. Revascularization was either for venous (n = 12) or arterial (n = 14) vessels, and a total of 30 allografts revascularized the superior vena cava (n = 6), pulmonary artery (n = 7), innominate vein (n = 3) or artery (n = 2), ascendent (n = 4) or descending (n = 1) aorta, and subclavian vein (n = 3) or artery (n = 4). Hospital morbidity and mortality were 50% (n = 13) and 3.8% (n = 1), respectively, all CAA unrelated. With a median follow-up of 18 months (range, 3 to 60+), 5-year survival and allograft patency were 84% and 95%, respectively. Preoperative anti-HLA antibodies were detected in 2 patients (7.7%) and a postoperative anti-HLA antibody response, clinically irrelevant, in 1 of 24 patients (4%).
Revascularization of intrathoracic venous and arterial vessels in patients with malignancies using HLA- and ABO-mismatched CAA is technically feasible and clinically attractive because of no infection risk and postoperative anticoagulation, and excellent long-term survival, patency, and nonimmunogeneicity.
本研究旨在评估使用冷冻保存的动脉同种异体移植物（CAA）对受恶性肿瘤侵犯的胸内血管进行血运重建的长期临床和免疫结果。
自2002年1月起，对连续的胸内血管受恶性肿瘤侵犯的患者进行手术，并使用人类淋巴细胞抗原（HLA）和ABO血型不匹配的CAA进行血运重建。术前以及术后1、3、6、12和24个月进行免疫研究。术后未给予口服抗凝治疗。
26例年龄为53.1±15岁的患者接受了手术，其中非小细胞肺癌（n = 10）、侵袭性纵隔肿瘤（n = seven）、肺动脉肉瘤（n = 3）、喉癌（n = 2）或其他罕见的肺部肿瘤（n = 4）。10例（38%）患者使用了体外循环，所有切除在病理上均为完全切除。血运重建用于静脉（n = 12）或动脉（n = 14）血管，总共30个同种异体移植物为上腔静脉（n = 6）、肺动脉（n = 7）、无名静脉（n = 3）或动脉（n = 2）、升主动脉（n = 4）或降主动脉（n = 1）以及锁骨下静脉（n = 3）或动脉（n = 4）进行了血运重建。医院发病率和死亡率分别为50%（n = 13）和3.8%（n = 1），均与CAA无关。中位随访时间为18个月（范围为3至60 +），5年生存率和同种异体移植物通畅率分别为84%和95%。2例患者（7.7%）术前检测到抗HLA抗体，24例患者中有1例（4%）术后出现抗HLA抗体反应，临床意义不大。
使用HLA和ABO血型不匹配的CAA对恶性肿瘤患者的胸内静脉和动脉血管进行血运重建在技术上是可行的，并且在临床上具有吸引力，因为没有感染风险和术后抗凝，且长期生存率、通畅率和非免疫原性良好。
