Levvey B J, Whitford H M, Williams T J, Westall G P, Paraskeva M, Manterfield C, Miller T, McGiffin D, Snell G I
Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
Am J Transplant. 2015 Dec;15(12):3208-14. doi: 10.1111/ajt.13388. Epub 2015 Jul 17.
Lung transplantation (LTx) is a therapeutic option for severe pulmonary arterial hypertension (PAH) patients failing optimal medical therapy. The use of donation after circulatory determination of death (DCDD) donor lungs for PAH LTx has rarely been reported, primarily reflecting concerns that DCDD lungs represent extended criteria donors, at risk of morbidity and mortality. A retrospective study of all Alfred Hospital DCDD and DNDD (donation after neurologic determination of death) PAH LTx was undertaken. Protocolized fluid/inotrope/ventilator and extracorporeal membrane oxygenation (ECMO) strategies were utilized. Since our first DCDD LTx in 2006, 512 LTx have been performed. Of 31 PAH recipients, 11 received DCDD lungs (11% of DCDD LTx) and 20 received DNDD lungs (5% of DNDD LTx) (p = 0.04). Only one PAH patient died on the LTx waiting list. Peri-LTx ECMO was utilized in 3/11 (27%) DCDD and 6/20 (30%) DNDD PAH LTx (p = 0.68). Primary graft dysfunction, intensive care, and overall stay were the same in both groups. Survival at 1 and 8 years was 100% and 80% for DCDD versus 100% and 70% for DNDD LTx (p = 0.88), respectively. In conclusion, excellent results can be achieved for PAH LTx. DCDD donor lungs are not extended lungs per se having passed the toughest test.
肺移植（LTx）是重症肺动脉高压（PAH）患者在最佳药物治疗失败后的一种治疗选择。使用循环判定死亡后捐赠（DCDD）供体肺进行PAH-LTx的报道很少，这主要反映了人们担心DCDD肺代表扩大标准供体，存在发病和死亡风险。对阿尔弗雷德医院所有DCDD和神经学判定死亡后捐赠（DNDD）的PAH-LTx进行了一项回顾性研究。采用了标准化的液体/血管活性药物/呼吸机和体外膜肺氧合（ECMO）策略。自2006年我们首次进行DCDD-LTx以来，已进行了512例肺移植。在31例PAH受者中，11例接受了DCDD肺（占DCDD-LTx的11%），20例接受了DNDD肺（占DNDD-LTx的5%）（p=0.04）。只有1例PAH患者在肺移植等待名单上死亡。3/11（27%）的DCDD和6/20（30%）的DNDD PAH-LTx使用了围手术期ECMO（p=0.68）。两组的原发性移植物功能障碍、重症监护和总体住院时间相同。DCDD组1年和8年生存率分别为100%和80%，DNDD-LTx组分别为100%和70%（p=0.88）。总之，PAH-LTx可以取得优异的结果。DCDD供体肺本身并非扩大标准供体肺，因为它们已经通过了最严格的测试。
