Hoshikawa Y, Okada Y, Ashikari J, Matsuda Y, Niikawa H, Noda M, Sado T, Watanabe T, Notsuda H, Chen F, Inoue M, Miyoshi K, Shiraishi T, Miyazaki T, Chida M, Fukushima N, Kondo T
Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan.
Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan.
Transplant Proc. 2015 Apr;47(3):746-50. doi: 10.1016/j.transproceed.2014.12.041.
Because the shortage of donor organs is especially serious in Japan, since 2002 a unique partnership between transplant consultant physicians and local physicians has been developed to maximize the organ utilization rate. Since 2011, more than 25 lung consultant physicians have been registered to specifically assess donor lungs and provide advice on intensive respiratory care to donors. In this study, we retrospectively reviewed the efficacy of this system for lung transplantation opportunities and outcomes. One hundred eighty-seven brain-dead lung donor candidates were chronologically divided into 3 phases: I (May 1998-November 2006) and II (December 2006-January 2011), before and after medical consultants requested that local physicians administer aggressive bronchial suctioning using bronchoscopy, respectively; and phase III (February 2011-January 2013), after the emergence of lung consultants. The lung utilization rate, Pao2/Fio2 ratio at the first and second brain death examinations and at the tertiary assessment before recovery, and graft survival were analyzed. The lung utilization rate was significantly higher in phases II and III than in phase I. In phases I and II, the Pao2/Fio2 ratio at the tertiary assessment was significantly lower than that at the first or the second brain death examination, whereas it did not worsen with time in phase III. Graft survival was significantly better in phases II and III than in phase I. Graft death due to primary graft dysfunction was significantly more frequent in phase I than in phases II and III. In conclusion, this system is effective in improving lung transplantation opportunities and outcomes.
由于供体器官短缺问题在日本尤为严重，自2002年起，移植顾问医生与当地医生建立了独特的合作关系，以最大限度提高器官利用率。自2011年以来，已有超过25名肺移植顾问医生登记在册，专门评估供体肺，并为供体提供强化呼吸护理方面的建议。在本研究中，我们回顾性分析了该系统对肺移植机会和结果的有效性。187名脑死亡肺供体候选者按时间顺序分为3个阶段：阶段I（1998年5月至2006年11月）和阶段II（2006年12月至2011年1月），分别是医学顾问要求当地医生使用支气管镜进行积极支气管抽吸之前和之后；以及阶段III（2011年2月至2013年1月），即肺移植顾问出现之后。分析了肺利用率、首次和第二次脑死亡检查时以及恢复前三级评估时的动脉血氧分压/吸入氧分数值（Pao2/Fio2）比值，以及移植物存活率。阶段II和III的肺利用率显著高于阶段I。在阶段I和II中，三级评估时的Pao2/Fio2比值显著低于首次或第二次脑死亡检查时的值，而在阶段III中该比值并未随时间恶化。阶段II和III的移植物存活率显著优于阶段I。因原发性移植物功能障碍导致的移植物死亡在阶段I比在阶段II和III中更为频繁。总之，该系统在改善肺移植机会和结果方面是有效的。
