Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Eur J Cardiothorac Surg. 2011 Jan;39(1):115-9. doi: 10.1016/j.ejcts.2010.05.019. Epub 2010 Jul 1.
The limited number of available grafts is one of the major obstacles of lung transplantation. Size-reduced lung transplantation allows the use of oversized grafts for small recipients. Optimal lung size matching is vital to achieve best functional outcome and avoid potential problems when using oversized grafts. We hypothesise that donor-predicted postoperative forced expiratory volume in 1s (ppoFEV1) correlates with the recipient best FEV1 after size-reduced lung transplant, being useful for the estimation of function outcome.
All patients undergoing size-reduced or standard bilateral lung transplantation were included (1992-2007). Donor ppoFEV1 was calculated and corrected with respect to size reduction and correlated with recipient measured best FEV1 post-transplant. In addition, pre- and postoperative clinical data including surgical complications and outcome of all size-reduced lung transplant recipients were compared with standard lung transplant recipients.
A total of 61 size-reduced lung transplant recipients (lobar transplants, n=20; anatomic or non-anatomic resection, n=41) were included and compared to 145 standard transplants. The mean donor-recipient height difference was statistically significant between the two groups (p=0.0001). The mean donor ppoFEV1 was comparable with recipient best FEV1 (2.7±0.6 vs 2.6±0.7 l). There was a statistically significant correlation between donor ppoFEV1 and recipient best FEV1 (p=0.01, r=0.688). The 30-day mortality rate and 3-month, 1- and 5-year survival rates were comparable between the two groups.
In size-reduced lung transplantation, postoperative recipient best FEV1 could be predicted from donor-calculated and corrected FEV1 with respect to its size reduction. Compared to standard lung transplantation, equivalent morbidity, mortality and functional results could be obtained after size-reduced lung transplantation.
可供移植的肺脏数量有限是肺移植的主要障碍之一。肺脏缩小移植可以使供体肺脏在受体中发挥作用，即使供体肺脏体积过大。最佳的肺脏大小匹配对于实现最佳功能结果和避免使用过大供体肺脏时出现潜在问题至关重要。我们假设供体预测的术后用力呼气量 1 秒率（ppoFEV1）与缩小肺脏移植后受体的最佳 FEV1 相关，这对于评估功能结果很有用。
纳入所有接受缩小或标准双侧肺脏移植的患者（1992-2007 年）。计算供体ppoFEV1 并根据缩小比例进行校正，并与移植后受体测量的最佳 FEV1 相关。此外，比较了所有缩小肺脏移植受者的术前和术后临床数据，包括手术并发症和结果，与标准肺脏移植受者进行比较。
共纳入 61 例缩小肺脏移植受者（肺叶移植 20 例；解剖或非解剖性切除 41 例），并与 145 例标准移植进行比较。两组间供体-受体身高差异具有统计学意义（p=0.0001）。供体ppoFEV1 与受体最佳 FEV1 相当（2.7±0.6 比 2.6±0.7 l）。供体ppoFEV1 与受体最佳 FEV1 之间存在统计学显著相关性（p=0.01，r=0.688）。两组间 30 天死亡率和 3 个月、1 年和 5 年生存率相当。
在缩小肺脏移植中，受体术后最佳 FEV1 可以根据其缩小比例从供体计算和校正的 FEV1 中预测。与标准肺脏移植相比，缩小肺脏移植后可获得相当的发病率、死亡率和功能结果。
