Colman Rebecca, Singer Lianne G, Barua Reeta, Downar James
Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.
Palliat Med. 2015 May;29(5):429-35. doi: 10.1177/0269216314566839. Epub 2015 Jan 29.
Lung transplant candidates experience important symptoms, but they are rarely referred for palliative care consultation until they are deemed ineligible for transplant. Our lung transplant service has a high rate of palliative care referral for patients awaiting transplant.
We reviewed the characteristics, interventions, and outcomes of lung transplant candidates referred for co-management by palliative care, to determine whether they safely received opioids and went on to transplantation.
Retrospective review of lung transplant candidates referred to our palliative care consultation service between January 2010 and May 2012.
Of 308 lung transplant candidates, 64 (20.7%) were referred to palliative care. Most had interstitial lung disease and were referred for dyspnea and a rapidly deteriorating course. A total of 59 (92%) were prescribed opioids for dyspnea, 55/59 used the opioids more than once, and 38/59 were maintained on standing opioids. There were no episodes of clinically important opioid toxicity or respiratory depression, and there was a trend toward increased exertion during exercise sessions post-opioid versus pre-opioid (19.3 vs 17.0 kcal, respectively, p = 0.06). At last follow-up, 30 (47%) had been transplanted, 23 (36%) had died while on the wait-list, 9 (14%) had died after delisting, and 2 (3%) were still awaiting transplantation. Of the 30 patients who underwent lung transplantation, only 7 (23%) still required an opioid prescription 1 month post-discharge.
In lung transplant candidates, palliative care and opioids in particular can be safely provided without compromising eligibility for transplantation. Palliative care should not be delayed until a patient is deemed ineligible for transplant.
肺移植候选者会经历一些重要症状，但在被判定不适合移植之前，他们很少会被转介进行姑息治疗咨询。我们的肺移植服务对等待移植的患者进行姑息治疗转介的比例很高。
我们回顾了被转介接受姑息治疗共同管理的肺移植候选者的特征、干预措施和结局，以确定他们是否安全地接受了阿片类药物治疗并最终接受了移植。
对2010年1月至2012年5月期间转介至我们姑息治疗咨询服务的肺移植候选者进行回顾性研究。
在308名肺移植候选者中，64名（20.7%）被转介接受姑息治疗。大多数患有间质性肺病，因呼吸困难和病情迅速恶化而被转介。共有59名（92%）因呼吸困难而被开具阿片类药物，55/59名不止一次使用阿片类药物，38/59名持续使用常规阿片类药物。没有发生具有临床意义的阿片类药物毒性或呼吸抑制事件，并且与使用阿片类药物前相比，使用阿片类药物后运动期间的运动量有增加的趋势（分别为19.3千卡和17.0千卡，p = 0.06）。在最后一次随访时，30名（47%）已接受移植，23名（36%）在等待名单上死亡，9名（14%）在被除名后死亡，2名（3%）仍在等待移植。在接受肺移植的30名患者中，只有7名（23%）在出院1个月后仍需要阿片类药物处方。
对于肺移植候选者，尤其是姑息治疗和阿片类药物，可以安全地提供，而不会影响移植资格。不应等到患者被判定不适合移植才延迟姑息治疗。
