Washington University School of Medicine, St. Louis, MO, USA.
Am J Transplant. 2010 Apr;10(4 Pt 2):1047-68. doi: 10.1111/j.1600-6143.2010.03055.x.
This article highlights trends and changes in lung and heart-lung transplantation in the United States from 1999 to 2008. While adult lung transplantation grew significantly over the past decade, rates of heart-lung and pediatric lung transplantation have remained low. Since implementation of the lung allocation score (LAS) donor allocation system in 2005, decreases in the number of active waiting list patients, waiting times for lung transplantation and death rates on the waiting list have occurred. However, characteristics of recipients transplanted in the LAS era differed from those transplanted earlier. The proportion of candidates undergoing lung transplantation for chronic obstructive pulmonary disease decreased, while increasing for those with pulmonary fibrosis. In the LAS era, older, sicker and previously transplanted candidates underwent transplantation more frequently compared with the previous era. Despite these changes, when compared with the pre-LAS era, 1-year survival after lung transplantation did not significantly change after LAS inception. The long-term effects of the change in the characteristics of lung transplant recipients on overall outcomes for lung transplantation remain unknown. Continued surveillance and refinements to the LAS system will affect the distribution and types of candidates transplanted and hopefully lead to improved system efficiency and outcomes.
本文重点介绍了 1999 年至 2008 年美国肺和心肺移植的趋势和变化。尽管过去十年成人肺移植显著增长，但心肺和儿科肺移植的比例仍保持在较低水平。自 2005 年实施肺分配评分（LAS）供体分配系统以来，活跃的候补名单患者数量、肺移植等待时间和候补名单上的死亡率均有所下降。然而，在 LAS 时代接受移植的受者的特征与早些时候接受移植的受者不同。接受肺移植治疗慢性阻塞性肺疾病的患者比例下降，而患有肺纤维化的患者比例上升。在 LAS 时代，与前一时期相比，年龄更大、病情更严重和以前接受过移植的患者更频繁地接受移植。尽管发生了这些变化，但与 LAS 实施前相比，肺移植后 1 年的生存率在 LAS 实施后并没有显著改变。肺移植受者特征变化对肺移植总体结果的长期影响仍不清楚。持续监测和完善 LAS 系统将影响移植候选者的分布和类型，并有望提高系统效率和结果。
