连续54例肺移植后的长期并发症。
Long term complications following 54 consecutive lung transplants.
作者信息
Tabarelli Walther, Bonatti Hugo, Tabarelli Dominique, Eller Miriam, Müller Ludwig, Ruttmann Elfriede, Lass-Flörl Cornelia, Larcher Clara, Geltner Christian
机构信息
1 Liechtensteinisches Landesspital, Vaduz, Liechtenstein ; 2 Department of Surgery, University of Maryland, Shore Health System, Easton, MD, USA ; 3 State Hospital Natters-Hochzirl, Innsbruck, Austria ; 4 Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria ; 5 Medical University Innsbruck, Department Hygiene and Microbiology, Innsbruck, Austria ; 6 MB-LAB Mikrobiologisches Labor, Innsbruck, Austria ; 7 Kreisklinik Bad Reichenhall, Pulmonology, Bad Reichenhall, Germany.
出版信息
J Thorac Dis. 2016 Jun;8(6):1234-44. doi: 10.21037/jtd.2016.05.03.
BACKGROUND
Due to the complex therapy and the required high level of immunosuppression, lung recipients are at high risk to develop many different long term complications.
METHODS
From 1993-2000, a total of 54 lung transplantation (LuTx) were performed at our center. Complications, graft and patient survival of this cohort was retrospectively analyzed.
RESULTS
One/five and ten-year patient survival was 71.4%, 41.2% and 25.4%; at last follow up (4/2010), twelve patients were alive. Of the 39 deceased patients, 26 died from infectious complications. Other causes of death were myocardial infarction (n=1), progressive graft failure (n=1), intracerebral bleeding (n=2), basilary vein thrombosis (n=1), pulmonary emboli (n=1), others (n=7). Surgical complication rate was 27.7% during the first year and 25% for the 12 long term survivors. Perioperative rejection rate was 35%, and 91.6% for the 12 patients currently alive. Infection incidence during first hospitalization was 79.6% (1.3 episodes per transplant) and 100% for long term survivors. Commonly isolated pathogens were cytomegalovirus (56.8%), Aspergillus (29.4%), RSV (13.7%). Other common complications were renal failure (56.8%), osteoporosis (54.9%), hypertension (45%), diabetes mellitus (19.6%).
CONCLUSIONS
Infection and rejection remain the most common complications following LuTx with many other events to be considered.
背景
由于治疗复杂且需要高水平的免疫抑制，肺移植受者发生多种不同长期并发症的风险很高。
方法
1993年至2000年，我们中心共进行了54例肺移植手术。对该队列的并发症、移植物和患者生存率进行了回顾性分析。
结果
1年、5年和10年的患者生存率分别为71.4%、41.2%和25.4%；在最后一次随访（2010年4月）时，有12名患者存活。在39例死亡患者中，26例死于感染性并发症。其他死亡原因包括心肌梗死（n = 1）、移植物进行性衰竭（n = 1）、脑出血（n = 2）、基底静脉血栓形成（n = 1）、肺栓塞（n = 1）、其他（n = 7）。第一年的手术并发症发生率为27.7%，12名长期存活者的手术并发症发生率为25%。围手术期排斥反应发生率为35%，目前存活的12名患者的排斥反应发生率为91.6%。首次住院期间的感染发生率为79.6%（每次移植1.3次发作），长期存活者的感染发生率为100%。常见的分离病原体为巨细胞病毒（56.8%）、曲霉菌（29.4%）、呼吸道合胞病毒（13.7%）。其他常见并发症包括肾衰竭（56.8%）、骨质疏松症（54.9%）、高血压（45%）、糖尿病（19.6%）。
结论
感染和排斥反应仍然是肺移植后最常见的并发症，还需考虑许多其他情况。
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