双侧肺移植术后肺大小不匹配与原发性移植肺功能障碍
Lung size mismatch and primary graft dysfunction after bilateral lung transplantation.
作者信息
Eberlein Michael, Reed Robert M, Bolukbas Servet, Diamond Joshua M, Wille Keith M, Orens Jonathan B, Brower Roy G, Christie Jason D
机构信息
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
出版信息
J Heart Lung Transplant. 2015 Feb;34(2):233-40. doi: 10.1016/j.healun.2014.09.030. Epub 2014 Sep 28.
BACKGROUND
Donor-to-recipient lung size matching at lung transplantation (LTx) can be estimated by the predicted total lung capacity (pTLC) ratio (donor pTLC/recipient pTLC). We aimed to determine whether the pTLC ratio is associated with the risk of primary graft dysfunction (PGD) after bilateral LTx (BLT).
METHODS
We calculated the pTLC ratio for 812 adult BLTs from the Lung Transplant Outcomes Group between March 2002 to December 2010. Patients were stratified by pTLC ratio >1.0 ("oversized") and pTLC ratio ≤1.0 ("undersized"). PGD was defined as any ISHLT Grade 3 PGD (PGD3) within 72 hours of reperfusion. We analyzed the association between risk factors and PGD using multivariable conditional logistic regression. As transplant diagnoses can influence the size-matching decisions and also modulate the risk for PGD, we performed pre-specified analyses by assessing the impact of lung size mismatch within diagnostic categories.
RESULTS
In univariate analyses oversizing was associated with a 39% lower odds of PGD3 (OR 0.61, 95% CI, 0.45-0.85, p = 0.003). In a multivariate model accounting for center-effects and known PGD risks, oversizing remained independently associated with a decreased odds of PGD3 (OR 0.58, 95% CI 0.38 to 0.88, p = 0.01). The risk-adjusted point estimate was similar for the non-COPD diagnosis groups (OR 0.52, 95% CI 0.32 to 0.86, p = 0.01); however, there was no detected association within the COPD group (OR 0.72, 95% CI 0.29 to 1.78, p = 0.5).
CONCLUSION
Oversized allografts are associated with a decreased risk of PGD3 after BLT; this effect appears most apparent in non-COPD patients.
背景
肺移植（LTx）时供体与受体肺大小匹配情况可通过预测总肺容量（pTLC）比值（供体pTLC/受体pTLC）来评估。我们旨在确定pTLC比值是否与双侧肺移植（BLT）后原发性移植物功能障碍（PGD）的风险相关。
方法
我们计算了2002年3月至2010年12月期间肺移植结果研究组812例成人BLT的pTLC比值。患者按pTLC比值>1.0（“过大”）和pTLC比值≤1.0（“过小”）进行分层。PGD定义为再灌注72小时内出现的任何国际心脏和肺移植学会3级PGD（PGD3）。我们使用多变量条件逻辑回归分析危险因素与PGD之间的关联。由于移植诊断可影响大小匹配决策，也可调节PGD风险，我们通过评估诊断类别内肺大小不匹配的影响进行了预先指定的分析。
结果
在单变量分析中，供体肺过大与PGD3发生几率降低39%相关（比值比[OR]0.61，95%置信区间[CI]，0.45 - 0.85，p = 0.003）。在考虑中心效应和已知PGD风险的多变量模型中，供体肺过大仍与PGD3发生几率降低独立相关（OR 0.58，95% CI 0.38至0.88，p = 0.01）。非慢性阻塞性肺疾病（COPD）诊断组的风险调整点估计值相似（OR 0.52，95% CI 0.32至0.86，p = 0.01）；然而，在COPD组中未检测到关联（OR 0.72，95% CI 0.29至1.78，p = 0.5）。
结论
供体肺过大与BLT后PGD3风险降低相关；这种效应在非COPD患者中似乎最为明显。
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