双侧肺移植后慢性阻塞性肺疾病合并肺动脉高压的不良结局
Adverse outcomes associated with pulmonary hypertension in chronic obstructive pulmonary disease after bilateral lung transplantation.
作者信息
Hayes Don, Tumin Dmitry, Budev Maria M, Tobias Joseph D, St John Roy C, Kukreja Jasleen
机构信息
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
出版信息
Respir Med. 2017 Jul;128:102-108. doi: 10.1016/j.rmed.2017.04.010. Epub 2017 Apr 22.
BACKGROUND
The impact of pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) on survival after lung transplantation (LTx) is not known.
MATERIAL AND METHODS
First-time adult LTx recipients with COPD transplanted between May 2005 and September 2013 were identified in the United Network for Organ Sharing Registry database, and tracked from transplant date until death or censoring. Right heart catheterization (RHC) measurements at time of wait listing were used to predict all-cause mortality after LTx, with multivariable analyses stratified by transplant type.
RESULTS
Of 3362 COPD LTx recipients, 3105 were included in the analytic sample, with multiple imputation used to complete missing data on covariates. Multivariable analysis found the hazard of death to increase with a 10 mmHg increase in mean pulmonary artery pressure (mPAP) among recipients of bilateral LTx (HR = 1.12; 95% CI = 1.01, 1.24; p = 0.032), but not among recipients of single LTx (HR = 0.92; 95% CI = 0.80, 1.06; p = 0.234).
CONCLUSION
PH prior to bilateral LTx in patients with COPD is associated with higher mortality risk.
背景
慢性阻塞性肺疾病（COPD）合并肺动脉高压（PH）对肺移植（LTx）术后生存的影响尚不清楚。
材料与方法
在器官共享联合网络登记数据库中识别出2005年5月至2013年9月期间首次接受LTx的成年COPD患者，并从移植日期开始跟踪直至死亡或失访。等待名单时的右心导管检查（RHC）测量值用于预测LTx后的全因死亡率，并按移植类型进行多变量分析。
结果
在3362例COPD-LTx受者中，3105例纳入分析样本，采用多重填补法补齐协变量的缺失数据。多变量分析发现，双侧LTx受者中，平均肺动脉压（mPAP）每升高10 mmHg，死亡风险增加（HR = 1.12；95%CI = 1.01，1.24；p = 0.032），但单侧LTx受者中未观察到该现象（HR = 0.92；95%CI = 0.80，1.06；p = 0.234）。
结论
COPD患者双侧LTx术前的PH与较高的死亡风险相关。
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