Lung Transplant Program, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, C 33 GH, Iowa City, IA 52242, USA.
Ann Thorac Surg. 2013 Aug;96(2):457-63. doi: 10.1016/j.athoracsur.2013.04.064. Epub 2013 Jun 26.
A higher predicted total lung capacity (pTLC)-ratio (=pTLC donor/pTLC recipient), suggestive of oversized allografts, is associated with improved survival after lung transplantation. It is unknown whether the pTLC-ratio has a different association with survival in bilateral (BLT) versus single lung transplantation (SLT).
The pTLC-ratio was calculated for all adult patients in the United Network of Organ Sharing lung transplant (LTx) registry who underwent first-time LTx in the post lung allocation score era, between May 2005 and April 2010. The LTx recipients were stratified according to procedure (BLT vs SLT). Risk of death at 1 year after LTx was analyzed using Kaplan-Meier survival and Cox proportional hazards models.
In the 4,520 BLT patients, each 0.1 increase in pTLC-ratio conferred a 7% decrease in the hazard for death at 1 year (p < 0.001) in univariate analysis. This association remained significant after controlling for diagnosis, comorbidities, acuity, donor, and transplant factors (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.88 to 0.98, p = 0.01). Additional adjustment by a propensity score to account for biases to oversizing showed similar results (HR 0.94, 95% CI 0.90 to 0.99, p = 0.018). In the 2,477 SLT patients, each 0.1 increase in pTLC-ratio conveyed a 6% decrease in the hazard for death at 1 year (p = 0.002) in univariate analysis, which did not persist in the multivariate model (HR 1.00, p = 0.8).
A higher pTLC-ratio, suggestive of an oversized allograft, is associated with improved survival after lung transplantation. This association is primarily evident in BLT patients.
预测的全肺容量比（pTLC-ratio，即供体 pTLC/受体 pTLC）较高，提示供体肺体积过大，与肺移植后生存率提高相关。但尚不清楚 pTLC-ratio 与双肺移植（BLT）和单肺移植（SLT）后生存率的相关性是否不同。
在美国器官共享网络肺移植（LTx）登记处中，计算了在肺分配评分时代后，于 2005 年 5 月至 2010 年 4 月间接受首次 LTx 的所有成人患者的 pTLC-ratio。根据手术方式（BLT 与 SLT）对 LTx 受者进行分层。采用 Kaplan-Meier 生存分析和 Cox 比例风险模型分析 LTx 后 1 年的死亡风险。
在 4520 例 BLT 患者中，pTLC-ratio 每增加 0.1，1 年时死亡的风险就会降低 7%（p<0.001），在单因素分析中具有统计学意义。在校正诊断、合并症、疾病严重程度、供体和移植因素后，这种相关性仍然显著（风险比[HR]0.93，95%置信区间[CI]0.88 至 0.98，p=0.01）。通过倾向评分进一步调整，以考虑过大移植的偏倚，结果类似（HR 0.94，95%CI 0.90 至 0.99，p=0.018）。在 2477 例 SLT 患者中，pTLC-ratio 每增加 0.1，1 年时死亡的风险就会降低 6%（p=0.002），但在多因素模型中不具有统计学意义（HR 1.00，p=0.8）。
pTLC-ratio 较高提示供体肺体积过大，与肺移植后生存率提高相关。这种相关性主要在 BLT 患者中表现明显。
