King Christopher S, Khandhar Sandeep, Burton Nelson, Shlobin Oksana A, Ahmad Shahzad, Lefrak Edward, Barnett Scott D, Nathan Steven D
Department of Pulmonary/Critical Care Medicine, Walter Reed Army Medical Center, Washington, DC 20016, USA.
J Heart Lung Transplant. 2009 Aug;28(8):851-6. doi: 10.1016/j.healun.2009.04.023.
Single-lung transplant recipients may develop complications in their native lungs that may have an impact on outcomes. One potential therapeutic option is native lung pneumonectomy. The purpose of this study was to assess the impact of native lung complications on post-transplant survival in single-lung transplant recipients. We also aimed to determine the morbidity and mortality associated with native lung pneumonectomy (NLP). A retrospective review of all single-lung transplant recipients at our institution from January 1, 1998 to July 15, 2008 was performed. Patients were stratified to one of three groups: no native lung complications; native lung complications requiring native lung pneumonectomy; and native lung complications not managed with native lung pneumonectomy. Survival post-transplant and post-native lung complication were the primary end-points of the study. Significant native lung complications developed in 25 of 180 single-lung transplants (13.8%). Median post-transplant survival was lower in single-lung transplant recipients with significant native lung complications (3.2 years vs 5.3 years, p = 0.002). NLP was performed in 11 patients. Post-operative complications developed in 4 of 11 cases (36.4%), but all patients survived to hospital discharge. There was no significant difference in median survival between single-lung transplant recipients undergoing native lung pneumonectomy and single-lung transplant recipients without native lung complications (4.3 years vs 5.1 years, p = 0.478). Native lung complications impact post-transplant survival in single-lung transplant recipients and may partly explain why outcomes with single-lung transplantation are inferior to those of bilateral lung transplantation. NLP can be performed with acceptable morbidity and mortality.
单肺移植受者的自身肺脏可能会出现并发症，这可能会对治疗结果产生影响。一种潜在的治疗选择是切除自身肺脏。本研究的目的是评估自身肺脏并发症对单肺移植受者移植后生存率的影响。我们还旨在确定与切除自身肺脏（NLP）相关的发病率和死亡率。对1998年1月1日至2008年7月15日在我们机构接受单肺移植的所有受者进行了回顾性研究。患者被分为三组之一：无自身肺脏并发症；自身肺脏并发症需要切除自身肺脏；自身肺脏并发症未通过切除自身肺脏进行处理。移植后和自身肺脏出现并发症后的生存率是本研究的主要终点。180例单肺移植中有25例（13.8%）出现了严重的自身肺脏并发症。有严重自身肺脏并发症的单肺移植受者移植后的中位生存期较低（3.2年对5.3年，p = 0.002）。11例患者接受了切除自身肺脏手术。11例中有4例（36.4%）出现了术后并发症，但所有患者均存活至出院。接受切除自身肺脏手术的单肺移植受者与无自身肺脏并发症的单肺移植受者的中位生存期无显著差异（4.3年对5.1年，p = 0.478）。自身肺脏并发症会影响单肺移植受者移植后的生存率，这可能部分解释了为什么单肺移植的治疗结果不如双肺移植。切除自身肺脏手术可以在可接受的发病率和死亡率情况下进行。
