Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA.
J Heart Lung Transplant. 2010 Oct;29(10):1165-71. doi: 10.1016/j.healun.2010.05.014. Epub 2010 Jul 3.
Lung transplantation is the one form of solid-organ transplantation in which there is the option for patients to receive one or two organs. Idiopathic pulmonary fibrosis (IPF) candidates can be accommodated by either procedure but the decision about these two options remains controversial. Therefore, we sought to determine whether IPF patients listed for bilateral lung transplantation only had longer wait times and higher mortality on the waiting list than those listed for single lungs only. Patients with chronic obstructive pulmonary disease (COPD) were also analyzed as a comparison group.
This study was a retrospective analysis of the Organ Procurement and Transplantation Network database of patients with IPF and COPD listed for lung transplantation between May 2005 and December 2007. An analysis of wait times and mortality in this era as well as the pre-lung allocation score (pre-LAS) era of 2002 to 2004 was performed.
Of the 1,339 patients with IPF listed for lung transplantation, 31.7% were listed for bilateral lung transplantation only, 41% for single-lung transplantation only and 27.3% for either procedure. Patients listed for the bilateral procedure only were at greater risk of dying on the transplant list (p < 0.003), and were less likely to receive a lung transplant (p < 0.012). No difference in outcomes was seen in the COPD patients. Comparatively, in the pre-LAS era, wait times and mortality on the list for IPF patients were significantly greater for all forms of transplantation.
There has been a significant improvement in wait times and mortality for IPF patients since the inception of the LAS system. Nonetheless, despite the goal of transplant equity, IPF patients listed for bilateral lung transplantation might have a clinically meaningful increased risk of pre-transplant mortality. The choice of procedures therefore needs to be made with careful consideration of patients' survival both pre- and post-transplantation. Evaluation of transplant outcomes should not only be based on post-transplant survival, but should also account for the impact of the choice of procedure.
肺移植是实体器官移植的一种形式，患者可以选择接受一个或两个器官。特发性肺纤维化（IPF）患者可以通过这两种程序中的任何一种来进行治疗，但关于这两种选择的决策仍然存在争议。因此，我们试图确定仅列出双侧肺移植的 IPF 患者在等待名单上的等待时间是否更长，死亡率是否更高，而不是仅列出单肺移植。还分析了慢性阻塞性肺疾病（COPD）患者作为比较组。
本研究是对 2005 年 5 月至 2007 年 12 月期间列入肺移植名单的 IPF 和 COPD 患者的器官获取和移植网络数据库进行的回顾性分析。分析了这一时期以及 2002 年至 2004 年肺分配前评分（pre-LAS）时期的等待时间和死亡率。
在 1339 名列入肺移植名单的 IPF 患者中，31.7%仅列入双侧肺移植名单，41%仅列入单肺移植名单，27.3%列入任何一种程序。仅列入双侧程序的患者在移植名单上死亡的风险更高（p<0.003），并且更不可能接受肺移植（p<0.012）。COPD 患者的结果没有差异。相比之下，在 pre-LAS 时期，所有形式的移植的 IPF 患者的等待时间和名单上的死亡率都显著增加。
自 LAS 系统成立以来，IPF 患者的等待时间和死亡率有了显著改善。尽管有移植公平的目标，但列入双侧肺移植名单的 IPF 患者可能在移植前死亡的风险有临床意义的增加。因此，在选择程序时，需要仔细考虑患者在移植前后的生存情况。对移植结果的评估不仅应基于移植后的生存，还应考虑到程序选择的影响。
