Borro José M, Delgado María, Coll Elisabeth, Pita Salvador
José M Borro, María Delgado, Department of Thoracic Surgery and Lung Transplantation, Corunna University Hospital, 15006 Corunna, Spain.
World J Transplant. 2016 Jun 24;6(2):347-55. doi: 10.5500/wjt.v6.i2.347.
To performed remains a subject of debate and is the principal aim of the study.
This retrospective analysis included 73 patients with emphysema (2000-2012). The outcomes of patients undergoing single-lung transplantation (SL) (n = 40) or double-lung transplant (DL) (n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization (ONT).
Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL (P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL (P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterial respiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival (P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained (n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted (P = 0.875).
Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.
进行此项研究仍是一个有争议的话题，也是本研究的主要目的。
这项回顾性分析纳入了73例肺气肿患者（2000 - 2012年）。在Cox多变量分析中比较了接受单肺移植（SL）（n = 40）或双肺移植（DL）（n = 33）患者的结局，以研究手术技术、术后并发症以及急慢性排斥反应对生存率的影响。根据国际心肺移植学会标准选择患者纳入等待名单。每位患者的术前和术后康复与预防、手术技术及免疫抑制治疗均相似。研究期间西班牙全国范围内肺移植等待名单信息以及肺气肿患者移植后的回顾性生存数据，来自国家移植组织（ONT）管理的肺移植登记处。
两组在性别和临床特征方面具有可比性。我们发现两组间平均年龄存在显著差异，正如纳入标准所预期的，DL组患者更年轻。SL组围手术期并发症发生率为27.6%，DL组为54%（P = 0.032）。排除围手术期死亡率后，SL组的中位生存期为65.3个月，DL组为59.4个月（P = 0.96）。两组的闭塞性细支气管炎和总体5年生存率相似。SL组的细菌呼吸道感染、巨细胞病毒感染和真菌感染率较高，但无统计学意义。移植类型与生存率之间未发现差异（P = 0.48）。为支持我们的结果，获取了全国所有等待名单上肺气肿患者的数据（n = 1001）。SL组等待名单上的死亡率为2.4%，DL组为6.2%。235例接受SL移植和430例接受DL移植的患者5年生存率无差异（P = 0.875）。
我们的结果表明，肺气肿患者接受单肺移植与双肺移植的生存率相似，但术后并发症更少，等待名单上的死亡率显著更低。
