[肺移植治疗肺纤维化及其他间质性肺疾病]

[Lung transplantation in pulmonary fibrosis and other interstitial lung diseases].

作者信息

Berastegui Cristina, Monforte Victor, Bravo Carlos, Sole Joan, Gavalda Joan, Tenório Luis, Villar Ana, Rochera M Isabel, Canela Mercè, Morell Ferran, Roman Antonio

机构信息

Servei de Pneumologia, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital General Universitari Vall d'Hebron, Barcelona, España.

Servei de Cirurgia Toràcica, Hospital General Universitari Vall d'Hebron, Barcelona, España.

出版信息

Med Clin (Barc). 2014 Sep 15;143(6):239-44. doi: 10.1016/j.medcli.2013.06.026. Epub 2013 Sep 9.

DOI:10.1016/j.medcli.2013.06.026

PMID:24029451

Abstract

BACKGROUND AND OBJECTIVE

Interstitial lung disease (ILD) is the second indication for lung transplantation (LT) after emphysema. The aim of this study is to review the results of LT for ILD in Hospital Vall d'Hebron (Barcelona, Spain).

PATIENTS AND METHODS

We retrospectively studied 150 patients, 87 (58%) men, mean age 48 (r: 20-67) years between August 1990 and January 2010. One hundred and four (69%) were single lung transplants (SLT) and 46 (31%) bilateral-lung transplants (BLT). The postoperative diagnoses were: 94 (63%) usual interstitial pneumonia, 23 (15%) nonspecific interstitial pneumonia, 11 (7%) unclassifiable interstitial pneumonia and 15% miscellaneous. We describe the functional results, complications and survival.

RESULTS

The actuarial survival was 87, 70 and 53% at one, 3 and 5 years respectively. The most frequent causes of death included early graft dysfunction and development of chronic rejection in the form of bronchiolitis obliterans (BOS). The mean postoperative increase in forced vital capacity and forced expiratory volume in the first second (FEV1) was similar in SLT and BLT. The best FEV1 was reached after 10 (r: 1-36) months. Sixteen percent of patients returned to work. At some point during the evolution, proven acute rejection was diagnosed histologically in 53 (35%) patients. The prevalence of BOS among survivors was 20% per year, 45% at 3 years and 63% at 5 years.

CONCLUSIONS

LT is the best treatment option currently available for ILD, in which medical treatment has failed.

摘要

背景与目的

间质性肺疾病（ILD）是继肺气肿之后肺移植（LT）的第二大适应症。本研究旨在回顾西班牙巴塞罗那瓦尔德希伯伦医院ILD患者肺移植的结果。

患者与方法

我们回顾性研究了1990年8月至2010年1月期间的150例患者，其中男性87例（58%），平均年龄48岁（范围：20 - 67岁）。104例（69%）接受单肺移植（SLT），46例（31%）接受双肺移植（BLT）。术后诊断为：94例（63%）为普通型间质性肺炎，23例（15%）为非特异性间质性肺炎，11例（7%）为无法分类的间质性肺炎，15%为其他类型。我们描述了功能结果、并发症和生存率。

结果

1年、3年和5年的精算生存率分别为87%、70%和53%。最常见的死亡原因包括早期移植物功能障碍以及以闭塞性细支气管炎（BOS）形式出现的慢性排斥反应。SLT和BLT术后第1秒用力肺活量（FVC）和第1秒用力呼气容积（FEV1）的平均增加相似。最佳FEV1在术后10个月（范围：1 - 36个月）时达到。16%的患者恢复工作。在病程中的某个时间点，经组织学证实53例（35%）患者发生急性排斥反应。幸存者中BOS的发生率为每年20%，3年时为45%，5年时为63%。