He Wen-Xin, Yang Yu-Ling, Xia Yan, Song Nan, Liu Ming, Zhang Peng, Fan Jiang, Jiang Ge-Ning
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
Chin Med J (Engl). 2016 Jan 5;129(1):3-7. doi: 10.4103/0366-6999.172547.
The factors affecting the outcome of patients referred for lung transplantation (LTx) still have not been investigated extensively. The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx.
From January 2003 to November 2013, the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery, Shanghai Pulmonary Hospital were analyzed retrospectively. The relationship between predictors and survival was evaluated using the Kaplan-Meier method and the Cox proportional hazards model.
Twenty-five patients (24.3%) died while awaiting the LTx. Fifty patients (48.5%) underwent LTx, and 28 patients (27.2%) were still on the waitlist. Compared to the candidates with chronic obstructive pulmonary disease (COPD), patients with idiopathic pulmonary fibrosis (IPF) had a higher mortality while awaiting the LTx (40.0% vs. 12.3%, P = 0.003). Patients requiring mechanical ventilation (MV) had a higher mortality while waiting than others (50.0% vs. 20.2%, P = 0.038). Two variables, using MV and IPF but not COPD as primary disease, emerged as significant independent risk factors for death on the waitlist (hazard ratio [HR] = 56.048, 95% confidence interval [CI]: 3.935-798.263, P = 0.003 and HR = 14.859, 95% CI: 2.695-81.932, P = 0.002, respectively).
The type of end-stage lung disease, pulmonary hypertension, and MV may be distinctive prognostic factors for death while awaiting the LTx.
影响肺移植（LTx）转诊患者预后的因素尚未得到广泛研究。本研究的目的是描述患者的预后情况，并确定等待肺移植期间死亡的预后因素。
回顾性分析2003年1月至2013年11月期间转诊至上海肺科医院胸外科等待肺移植的103例终末期肺病患者的临床资料。采用Kaplan-Meier法和Cox比例风险模型评估预测因素与生存率之间的关系。
25例患者（24.3%）在等待肺移植期间死亡。50例患者（48.5%）接受了肺移植，28例患者（27.2%）仍在等待名单上。与慢性阻塞性肺疾病（COPD）患者相比，特发性肺纤维化（IPF）患者在等待肺移植期间的死亡率更高（40.0%对12.3%，P = 0.003）。需要机械通气（MV）的患者在等待期间的死亡率高于其他患者（50.0%对20.2%，P = 0.038）。两个变量，即使用机械通气和以IPF而非COPD作为主要疾病，成为等待名单上死亡的显著独立危险因素（风险比[HR]=56.048，95%置信区间[CI]：3.935 - 798.263，P = 0.003；HR = 14.859，95% CI：2.695 - 81.932，P = 0.002）。
终末期肺病的类型、肺动脉高压和机械通气可能是等待肺移植期间死亡的独特预后因素。
