Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California, San Francisco, USA.
Am J Transplant. 2011 Oct;11(10):2197-204. doi: 10.1111/j.1600-6143.2011.03684.x. Epub 2011 Aug 10.
Lung transplantation in mechanically ventilated (MV) patients has been associated with decreased posttransplant survival. Under the Lung Allocation Score (LAS) system, patients at greatest risk of death on the waiting list, particularly those requiring MV, are prioritized for lung allocation. We evaluated whether pretransplant MV is associated with poorer posttransplant survival in the LAS era. Using a national registry, we analyzed all adults undergoing lung transplantation in the United States from 2005 to 2010. Propensity scoring identified nonventilated matched referents for 419 subjects requiring MV at the time of transplantation. Survival was evaluated using Kaplan-Meier methods. Risk of death was estimated by hazard ratios employing time-dependent covariates. We found that pretransplant MV was associated with decreased overall survival after lung transplantation. In the first 6 months posttransplant, ventilated subjects had a twofold higher risk of death compared to nonventilated subjects. However, after 6 months posttransplant, survival did not differ by MV status. We also found that pretransplant MV was not associated with decreased survival in noncystic fibrosis obstructive lung diseases. These results suggest that under the LAS, pretransplant MV is associated with poorer short-term survival posttransplant. Notably, the increased risk of death appears to be strongest the early posttransplant period and limited to certain pretransplant diagnoses.
机械通气（MV）患者的肺移植与移植后生存率降低有关。在肺分配评分（LAS）系统下，等待名单上死亡风险最大的患者，特别是需要 MV 的患者，被优先分配肺。我们评估了在 LAS 时代，移植前 MV 是否与移植后生存率降低有关。我们使用国家登记处分析了 2005 年至 2010 年期间在美国接受肺移植的所有成年人。通过倾向评分，为 419 名移植时需要 MV 的患者确定了未通气的匹配参照者。使用 Kaplan-Meier 方法评估生存情况。使用时间依赖性协变量估计死亡风险的风险比。我们发现移植前 MV 与肺移植后总体生存率降低有关。在移植后 6 个月内，通气组的死亡风险是未通气组的两倍。然而，移植后 6 个月后，MV 状态与生存率无关。我们还发现，在非囊性纤维化阻塞性肺部疾病中，移植前 MV 与生存率降低无关。这些结果表明，在 LAS 下，移植前 MV 与移植后短期生存率降低有关。值得注意的是，死亡风险的增加似乎在移植后早期最强，并且仅限于某些移植前诊断。
