Vall d'Hebron University Hospital, Lung Transplant Team, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain.
Vall d'Hebron University Hospital, Lung Transplant Team, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Surgical Department, Universitat Autónoma de Barcelona, Spain.
Arch Bronconeumol. 2017 Aug;53(8):421-426. doi: 10.1016/j.arbres.2016.12.019. Epub 2017 Feb 27.
One-year survival in lung transplant is around 85%, but this figure has not increased in recent years, in spite of technical improvements.
Retrospective, multicenter cohort study. Data from 272 eligible adults with lung transplant were recorded at 7 intensive care units (ICU) in Spain in 2013. The objective was to identify variables that might help to guide future clinical interventions in order to reducethe risk of death in the postoperative period.
One patient (0.3%) died in the operating room and 27 (10%) within 90 days. Twenty (7.4%) died within 28 days, after a median of 14 ICU days. Grade 3 pulmonary graft dysfunction was documented in 108 patients, of whom 21 died, compared with 6 out of 163 without pulmonary graft dysfunction (P<.001). At ICU admission, non-survivors had significantly lower (P=.03) median PaO2/FiO2 (200mmHg vs 280mmHg), and the difference increased after 24hours (178 vs 297mmHg, P<.001). Thirteen required extracorporeal membrane oxygenation, and 7(53.8%) died. A logistic regression model identified pulmonary graft dysfunction (OR: 6.77), donor age>60yr (OR: 2.91) and SOFA>8 (OR: 2.53) as independent predictors of 90-day mortality. At ICU admission, higher median procalcitonin (1.6 vs 0.6) and lower median PaO2/FiO2 (200 vs 280mmHg) were significantly associated with mortality.
Graft dysfunction remains a significant problem in lung transplant. Early ICU interventions in patients with severe hypoxemia or high procalcitonin are crucial in order to lower mortality.
肺移植术后 1 年存活率约为 85%，但尽管技术有所改进，近年来这一数字并未增加。
回顾性、多中心队列研究。2013 年，西班牙 7 家重症监护病房（ICU）记录了 272 名符合条件的成人肺移植患者的数据。目的是确定可能有助于指导未来临床干预的变量，以降低术后死亡风险。
1 例（0.3%）患者在手术室死亡，27 例（10%）患者在术后 90 天内死亡。20 例（7.4%）患者在 28 天内死亡，中位 ICU 天数为 14 天。108 例患者存在 3 级肺移植物功能障碍，其中 21 例死亡，而 163 例无肺移植物功能障碍的患者中只有 6 例死亡（P<.001）。在 ICU 入院时，非幸存者的 PaO2/FiO2 中位数明显较低（P=.03）（200mmHg 与 280mmHg），24 小时后差异增加（178mmHg 与 297mmHg，P<.001）。13 例需要体外膜氧合，其中 7 例（53.8%）死亡。逻辑回归模型确定肺移植物功能障碍（OR：6.77）、供体年龄>60 岁（OR：2.91）和 SOFA>8（OR：2.53）是 90 天死亡率的独立预测因素。在 ICU 入院时，较高的降钙素原中位数（1.6 与 0.6）和较低的 PaO2/FiO2 中位数（200 与 280mmHg）与死亡率显著相关。
肺移植后移植物功能障碍仍然是一个严重的问题。对于严重低氧血症或降钙素原水平高的患者，早期 ICU 干预对于降低死亡率至关重要。
