Kristensen Anna Warncke, Mortensen Jann, Berg Ronan M G
Department of Clinical Physiology, Nuclear Medicine & PET, University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark.
Clin Transplant. 2017 Apr;31(4). doi: 10.1111/ctr.12922. Epub 2017 Mar 5.
Post-transplantation mortality after lung transplantation (LTX) is higher than for other solid organ transplantations. Thoracic surgery is associated with increased risk of thromboembolic complications, and as LTX recipients lack the collateral bronchial circulation, pulmonary thromboembolism (PTE) may represent a pertinent yet largely underdiagnosed cause of post-transplantation respiratory failure. In this systematic review, we sought to elucidate the occurrence and predilection site of PTE after LTX, and its potential impact on LTX-associated mortality. Based on twelve original articles identified by a systematic search strategy in PubMed, we found that PTE was reported in 4% of LTX recipients, and 38% of these events occurred within the first 30 days after the LTX procedure. In single-lung transplantation (SLTX) recipients, 12% were diagnosed with PTE, with 92% of these affecting the allograft. Of LTX patients diagnosed with PTE, 11% died within 1 year after LTX and 75% of these deaths occurred within the first 30 days. Our findings suggest that PTE is a potentially underdiagnosed cause of early post-LTX respiratory failure. This should be confirmed in larger studies with systematic follow-up diagnostic imaging.
肺移植（LTX）后的移植后死亡率高于其他实体器官移植。胸外科手术与血栓栓塞并发症风险增加相关，并且由于肺移植受者缺乏支气管侧支循环，肺血栓栓塞（PTE）可能是移植后呼吸衰竭的一个相关但很大程度上未被诊断的原因。在这项系统评价中，我们试图阐明肺移植后PTE的发生率、好发部位及其对肺移植相关死亡率的潜在影响。基于通过在PubMed中系统检索策略确定的12篇原始文章，我们发现4%的肺移植受者报告发生了PTE，其中38%的事件发生在肺移植手术后的前30天内。在单肺移植（SLTX）受者中，12%被诊断为PTE，其中92%影响移植肺。在被诊断为PTE的肺移植患者中，11%在肺移植后1年内死亡，其中75%的死亡发生在前30天内。我们的研究结果表明，PTE是肺移植后早期呼吸衰竭的一个潜在未被诊断的原因。这一点应在进行系统随访诊断成像的更大规模研究中得到证实。
