Glanville A R, Baldwin J C, Hunt S A, Theodore J
Respiratory Medicine, Concord Hospital, NSW.
Aust N Z J Med. 1990 Jun;20(3):208-14. doi: 10.1111/j.1445-5994.1990.tb01020.x.
We present cardiac and pulmonary function data obtained at serial annual reviews in 21 heart-lung transplant (HLT) recipients followed for up to four years postoperatively, reflecting the entire Stanford experience as of June 1987. A total of 50 cardiac catheterisation procedures and endomyocardial biopsies yielded the following results: rejection on biopsy (0/50) (0% of patients), angiographic coronary artery disease (1/50) (5%), pulmonary hypertension (2/50) (10%), elevated pulmonary vascular resistance (PVR) (1/50) (5%), and low cardiac index (CI) (4/50) (14%). Systemic hypertension was common, with an elevated systemic vascular resistance (SVR) (26/44) (76%) and an elevated mean aortic pressure (MAP) (22/44) (67%). Pulmonary function testing frequently revealed abnormalities. Airflow limitation was manifested by a reduction in both FEV1/FVC ratio (17/50) (52%) and FEF25-75 (30/50) (71%), and was often associated with arterial hypoxaemia (13/50) (52%). Subsequently, five patients with these findings have died with obliterative bronchiolitis (OB), one underwent retransplantation for OB, six have stable OB, and one has progressive OB. Length of survival was highly correlated with the resting PaO2 at the first annual review (r = 0.99) (p less than 0.001), and, to a lesser degree, on the reduction in FEF25-75 (r = 0.73) (p less than 0.05) and FEV1/FVC ratio (r = 0.77) (p less than 0.05). Resting PaO2 was determined by ventilatory (r = 0.80) (p less than 0.001) rather than circulatory factors and all patients with airflow limitation who died had OB at post-mortem examination. These results support the continued study of HLT as a therapeutic modality for selected patients with irreversible pulmonary hypertension. They demonstrate that, in the absence of severe OB, haemodynamics, cardiac function, and coronary patency are preserved for several years after HLT. Whereas the value of regular pulmonary function testing has become evident, there does not appear to be a clinical need for annual surveillance with invasive cardiac procedures in long-term survivors of HLT.
我们展示了21例心肺移植（HLT）受者在术后长达四年的连续年度复查中获得的心脏和肺功能数据，这些数据反映了截至1987年6月斯坦福大学的全部经验。总共进行了50次心导管检查和心内膜心肌活检，结果如下：活检发现排斥反应（0/50）（0%的患者）、血管造影显示冠状动脉疾病（1/50）（5%）、肺动脉高压（2/50）（10%）、肺血管阻力（PVR）升高（1/50）（5%）以及心脏指数（CI）降低（4/50）（14%）。系统性高血压很常见，体循环血管阻力（SVR）升高（26/44）（76%），平均主动脉压（MAP）升高（22/44）（67%）。肺功能测试经常显示异常。气流受限表现为FEV1/FVC比值降低（17/50）（52%）和FEF25 - 75降低（30/50）（71%），并且常伴有动脉低氧血症（13/50）（52%）。随后，有这些表现的5例患者死于闭塞性细支气管炎（OB），1例因OB接受了再次移植，6例OB病情稳定，1例OB病情进展。生存时间与首次年度复查时的静息PaO2高度相关（r = 0.99）（p < 0.001），在较小程度上与FEF25 - 75降低（r = 0.73）（p < 0.05）和FEV1/FVC比值降低（r = 0.77）（p < 0.05）相关。静息PaO2由通气因素决定（r = 0.80）（p < 0.001）而非循环因素，所有死于气流受限的患者尸检时均有OB。这些结果支持继续将HLT作为治疗某些不可逆肺动脉高压患者的一种治疗方式进行研究。它们表明，在没有严重OB的情况下，HLT术后数年血流动力学、心脏功能和冠状动脉通畅性得以保留。鉴于定期肺功能测试的价值已很明显，对于HLT长期存活者，似乎没有临床必要每年通过侵入性心脏检查进行监测。
