Diso D, Anile M, Patella M, Pecoraro Y, Rendina E A, Carillo C, Russo E, Onorati I, Angioletti D, Ruberto F, Mazzesi G, Marullo A G M, Frati G, Venuta F
University of Rome Sapienza, Rome, Italy.
Transplant Proc. 2013 Jan-Feb;45(1):346-8. doi: 10.1016/j.transproceed.2012.08.010.
Bilateral sequential lung transplantation (BSLT) is nowadays considered a valid therapeutic option for patients with end stage cystic fibrosis. We report our experience with 104 BSLTs in 101 patients. The overall survivals at 1, 3, 5, 10 years were 79%, 65%, 58%, and 42%, respectively. Perioperative mortality was 14.8% (n = 15). The leading causes of perioperative mortality were primary graft dysfunction and sepsis. Three patients were retransplanted owing to obliterative bronchiolitis. In 70 cases (69%), patients displayed ≥ 1 additional risk factors: previous lung resections, colonization by Burkholderia cepacia, diabetes, pneumothorax, or noninvasive ventilatory support. The mean preoperative 1-second forced expiratory volume of 0.69 ± 0.2 L (22%) increased to 85% at 1 year after the operation. The mean time on the waiting list was 12 ± 5 months. The 5 patients treated with extracorporeal membrane oxygenation before urgent transplantation were operated after 3, 5, 6, 30, and 3 days respectively. During the procedure, cardiopulmonary bypass was required in 33 patients (32%). Lung transplantation represents a unique opportunity to ameliorate the quality and improve the survival of patients affected by cystic fibrosis. Timing of referral and patient selection remain crucial for success.
双侧序贯肺移植（BSLT）如今被认为是终末期囊性纤维化患者的一种有效治疗选择。我们报告了我们在101例患者中进行104例双侧序贯肺移植的经验。1年、3年、5年和10年的总体生存率分别为79%、65%、58%和42%。围手术期死亡率为14.8%（n = 15）。围手术期死亡的主要原因是原发性移植物功能障碍和败血症。3例患者因闭塞性细支气管炎而接受再次移植。在70例（69%）患者中，显示出≥1个其他风险因素：既往肺切除术、洋葱伯克霍尔德菌定植、糖尿病、气胸或无创通气支持。术前平均第1秒用力呼气量为0.69±0.2 L（22%），术后1年增加到85%。平均等待时间为12±5个月。5例在紧急移植前接受体外膜肺氧合治疗的患者分别在3天、5天、6天、30天和3天后接受手术。在手术过程中，33例患者（32%）需要体外循环。肺移植为改善囊性纤维化患者的生活质量和提高生存率提供了一个独特的机会。转诊时机和患者选择对于成功仍然至关重要。
