支气管动脉血运重建与整块肺移植术在儿童中的应用。

Bronchial artery revascularization and en bloc lung transplant in children.

机构信息

Lung Transplant Program, Baylor College of Medicine, Houston, Texas; Lung Transplant Program, Texas Children's Hospital, Houston, Texas.

Lung Transplant Program, Texas Children's Hospital, Houston, Texas.

出版信息

J Heart Lung Transplant. 2016 Jan;35(1):122-129. doi: 10.1016/j.healun.2015.08.010. Epub 2015 Sep 3.

DOI:10.1016/j.healun.2015.08.010

PMID:26508727

Abstract

BACKGROUND

Long-term success in pediatric lung transplantation is limited by infection and bronchiolitis obliterans syndrome (BOS). The bilateral sequential lung transplantation (BSLT) technique may result in airway ischemia leading to bronchial stenosis, dehiscence, or loss of small airways. En bloc lung transplant (EBLT) with bronchial artery revascularization (BAR) minimizes airway ischemia, thus promoting superior airway healing. BAR also allows for safe tracheal anastomosis, circumventing the need for bilateral bronchial anastomoses in small children.

METHODS

This was a retrospective review of bilateral transplantations from 2005 to 2014. Both techniques were used in parallel. Redo and multiorgan transplants were excluded.

RESULTS

There were 119 recipients comprising 88 BSLTs and 31 EBLTs. Follow-up time was 3 years (interquartile range, 1-5 years). Donor ischemic and cardiopulmonary bypass times were not different between techniques (p = 0.48 and p = 0.18, respectively). Degree of graft dysfunction and cellular rejection scores were not different (p = 0.83 and p = 0.93, respectively). There were 3 hospital deaths after BSLT and 2 after EBLT (p = 0.60). Overall survival was 61% for the BSLT group and 77% for the EBLT group (p = 0.54). Freedom from BOS was 71% in the BSLT group and 94% in the EBLT group (p = 0.08). On routine bronchoscopy, 57% BSLT and 16% EBLT patients had 1 or more airway ischemic findings (p < 0.0001). Multivariate analysis showed BSLT was associated with higher ischemic injury (relative risk, 2.86; 95 confidence interval, 1.3-6.5; p = 0.01) and non-airway complications (relative risk, 4.62; 95% confidence interval, 1.1-20.2; p = 0.04) but not airway reinterventions (p = 0.07). Airway dehiscence occurred in 3 BSLT patients.

CONCLUSIONS

Pediatric EBLT with BAR can be safely performed without increasing operative or graft ischemic times. Airway ischemia and non-airway complications were significantly reduced when BAR was combined with tracheal anastomosis, potentially diminishing morbidity caused by anastomotic healing complications.

摘要

背景

小儿肺移植的长期成功率受感染和闭塞性细支气管炎综合征（BOS）的限制。双侧序贯肺移植（BSLT）技术可能导致气道缺血，从而导致支气管狭窄、裂开或小气道丧失。带支气管动脉再血管化（BAR）的整块肺移植（EBLT）可最大限度地减少气道缺血，从而促进气道愈合。BAR 还允许安全地进行气管吻合，避免在小儿中进行双侧支气管吻合。

方法

这是一项对 2005 年至 2014 年期间双侧移植的回顾性研究。两种技术同时平行使用。排除重复和多器官移植。

结果

共纳入 119 例受者，其中 88 例行 BSLT，31 例行 EBLT。随访时间为 3 年（四分位距，1-5 年）。两种技术之间供体缺血和体外循环时间无差异（p = 0.48 和 p = 0.18）。移植物功能障碍和细胞排斥评分无差异（p = 0.83 和 p = 0.93）。BSLT 后有 3 例院内死亡，EBLT 后有 2 例（p = 0.60）。BSLT 组总体生存率为 61%，EBLT 组为 77%（p = 0.54）。BSLT 组无 BOS 生存率为 71%，EBLT 组为 94%（p = 0.08）。常规支气管镜检查显示，57%的 BSLT 患者和 16%的 EBLT 患者有 1 种或多种气道缺血表现（p<0.0001）。多变量分析显示，BSLT 与更高的缺血损伤（相对风险，2.86；95%置信区间，1.3-6.5；p = 0.01）和非气道并发症（相对风险，4.62；95%置信区间，1.1-20.2；p = 0.04）相关，但与气道再介入无关（p = 0.07）。3 例 BSLT 患者发生气道裂开。