Thabut Gabriel, Christie Jason D, Ravaud Philippe, Castier Yves, Dauriat Gaëlle, Jebrak Gilles, Fournier Michel, Lesèche Guy, Porcher Raphaël, Mal Hervé
Hôpital Bichat, APHP et Université Paris-Diderot Paris-7, INSERM U738, INSERM U717, Paris, France.
Ann Intern Med. 2009 Dec 1;151(11):767-74. doi: 10.7326/0003-4819-151-11-200912010-00004.
Patients with end-stage idiopathic pulmonary fibrosis (IPF) are increasingly having bilateral rather than single-lung transplantation.
To compare survival after single and bilateral lung transplantation in patients with IPF.
Analysis of data from the United Network of Organ Sharing registry.
Transplantation centers in the United States.
3327 patients with IPF who had single (2146 patients [64.5%]) or bilateral (1181 patients [35.5%]) lung transplantation between 1987 and 2009.
Survival times and causes of death after lung transplantation. Selection bias was accounted for by multivariate risk adjustment, propensity score risk adjustment, and propensity-based matching.
Median survival time was longer after bilateral lung transplantation than single-lung transplantation (5.2 years [CI, 4.3 to 6.7 years] vs. 3.8 years [CI, 3.6 to 4.1 years]; P < 0.001). However, survival times for the 2 procedures did not differ after adjustment for baseline differences, with adjusted hazard ratios (HRs) for mortality with bilateral transplantation ranging from 0.89 (95% CI, 0.79 to 1.02) to 0.96 (CI, 0.77 to 1.20) in different analyses. Bilateral lung transplantation seemed to result in harm within the first year (HR, 1.18 [CI, 0.98 to 1.42]) but survival benefit thereafter (HR, 0.72 [CI, 0.59 to 0.87]). Primary graft failure was a more common cause of death among patients who had bilateral rather than single-lung transplantation (3.7% vs. 1.9%; P = 0.002). Cancer was a more common cause of death among patients who had single rather than bilateral lung transplantation (unadjusted HR for death among single vs. bilateral transplant recipients, 3.60 [CI, 2.16 to 6.05]; P <0.001).
Causes of death were ascertained without an adjudication committee and must be interpreted cautiously.
Survival did not differ between patients who had single and bilateral lung transplantation. Single-lung transplantation confers short-term survival benefit but long-term harm, whereas bilateral transplantation confers short-term harm but long-term survival benefit.
None.
终末期特发性肺纤维化（IPF）患者越来越多地接受双肺移植而非单肺移植。
比较IPF患者单肺移植和双肺移植后的生存率。
对器官共享联合网络登记处的数据进行分析。
美国的移植中心。
1987年至2009年间接受单肺移植（2146例患者[64.5%]）或双肺移植（1181例患者[35.5%]）的3327例IPF患者。
肺移植后的生存时间和死亡原因。通过多变量风险调整、倾向评分风险调整和基于倾向的匹配来考虑选择偏倚。
双肺移植后的中位生存时间长于单肺移植（5.2年[CI，4.3至6.7年]对3.8年[CI，3.6至4.1年]；P<0.001）。然而，在对基线差异进行调整后，两种手术的生存时间没有差异，在不同分析中，双肺移植的校正死亡风险比（HRs）范围为0.89（95%CI，0.79至1.02）至0.96（CI，0.77至1.20）。双肺移植在第一年似乎会导致伤害（HR，1.18[CI，0.98至1.42]），但此后有生存获益（HR，0.72[CI，0.59至0.87]）。原发性移植失败在双肺移植患者中是比单肺移植患者更常见的死亡原因（3.7%对1.9%；P = 0.002）。癌症在单肺移植患者中是比双肺移植患者更常见的死亡原因（单肺与双肺移植受者未校正的死亡HR，3.60[CI，2.16至6.05]；P<0.001）。
死亡原因未经裁决委员会确定，必须谨慎解释。
单肺移植和双肺移植患者的生存率没有差异。单肺移植带来短期生存获益但长期伤害，而双肺移植带来短期伤害但长期生存获益。
无。
