Gilljam Marita, Nyström Ulla, Dellgren Göran, Skog Ingrid, Hansson Lennart
Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur J Cardiothorac Surg. 2017 Mar 1;51(3):571-576. doi: 10.1093/ejcts/ezw328.
In Sweden, lung transplantation has been performed in patients with end-stage lung disease since 1990. We assessed survival after lung transplantation for cystic fibrosis (CF) with focus on early mortality and outcome for patients infected with certain multiresistant bacteria, considered a relative contraindication for lung transplantation.
Review of CF and transplant databases and patient charts. The Kaplan-Meier method and log-rank test were used for survival analysis and group comparison.
From November 1991 to December 2014, 115 transplantations were performed in 106 CF patients (9 retransplantations): 3 heart-lung, 106 double lung-, 1 double lobar- and 5 single lung transplantations, constituting 13% (115/909) of all lung-transplant procedures performed in Sweden. The mean age at surgery was 31 (SD 10, range 10-61) years and there were 48% females. Overall 1-year survival after lung transplantation for CF was 86.4%, 5-year survival was 73.7% and 10-year survival was 62.4%. The mean and median survival after transplantation were 13.1 (95% confidence interval (CI): 11-15.3) and 14.6 (95% CI: 9.3-19.8) years, respectively, and there was no significant difference for gender or transplant centre. Extracorporeal membrane oxygenation was used as a bridge to transplantation in 11 cases and five patients received reconditioned lungs. Vascular and infectious complications contributed to eight deaths within the first three postoperative months. The mean survival for 14 patients infected pretransplant with Mycobacterium abscessus or Burkholderia cepacia complex was 8.8 (95% CI: 6.1-11.6) years compared to 13.2 (95% CI: 10.9-15.8) years for patients negative for these bacteria. Nineteen patients (14% of all listed), of whom three were listed for retransplantation, died while waiting a median time of 94 days (range 4 days-2.5 years) after listing.
Survival after lung transplantation in Sweden is good, also for patients with pretransplant infection with M. abscessus or B. cepacia complex, and comparable to international data.
自1990年起，瑞典就已为终末期肺病患者实施肺移植手术。我们评估了囊性纤维化（CF）患者肺移植后的生存率，重点关注早期死亡率以及感染某些多重耐药菌患者的预后情况，这类感染被视为肺移植的相对禁忌证。
回顾CF和移植数据库以及患者病历。采用Kaplan-Meier法和对数秩检验进行生存分析和组间比较。
1991年11月至2014年12月，106例CF患者（9例再次移植）接受了115次移植手术：3例心肺联合移植、106例双肺移植、1例双叶肺移植和5例单肺移植，占瑞典所有肺移植手术的13%（115/909）。手术时的平均年龄为31岁（标准差10，范围10 - 61岁），女性占48%。CF患者肺移植后的总体1年生存率为86.4%，5年生存率为73.7%，10年生存率为62.4%。移植后的平均生存时间和中位生存时间分别为13.1年（95%置信区间（CI）：11 - 15.3）和14.6年（95%CI：9.3 - 19.8），性别和移植中心之间无显著差异。11例患者使用体外膜肺氧合作为移植桥梁，5例患者接受了翻新肺。血管和感染并发症导致术后前三个月内8例死亡。移植前感染脓肿分枝杆菌或洋葱伯克霍尔德菌复合体的14例患者的平均生存时间为8.8年（95%CI：6.1 - 11.6），而这些细菌检测阴性的患者平均生存时间为13.2年（95%CI：10.9 - 15.8）。19例患者（占所有登记患者的14%）死亡，其中3例登记接受再次移植，登记后中位等待时间为94天（范围4天 - 2.5年）。
在瑞典，肺移植后的生存率良好，对于移植前感染脓肿分枝杆菌或洋葱伯克霍尔德菌复合体患者也是如此，且与国际数据相当。
