高优先级分配对肺动脉高压患者肺移植及心肺移植的影响
Impact of High-Priority Allocation on Lung and Heart-Lung Transplantation for Pulmonary Hypertension.
作者信息
Savale Laurent, Le Pavec Jérôme, Mercier Olaf, Mussot Sacha, Jaïs Xavier, Fabre Dominique, O'Connell Caroline, Montani David, Stephan François, Sitbon Olivier, Simonneau Gérald, Dartevelle Philippe, Humbert Marc, Fadel Elie
机构信息
University Paris-Sud, Faculté de Médecine, Université-Paris-Saclay, Le Kremlin-Bicêtre; Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre; INSERM UMR_999, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson.
University Paris-Sud, Faculté de Médecine, Université-Paris-Saclay, Le Kremlin-Bicêtre; INSERM UMR_999, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Le Plessis Robinson, Paris-Sud University, Paris, France.
出版信息
Ann Thorac Surg. 2017 Aug;104(2):404-411. doi: 10.1016/j.athoracsur.2017.02.034. Epub 2017 May 18.
BACKGROUND
Since 2006 and 2007, patients in France with severe pulmonary hypertension (PH) who are at imminent risk of death, despite optimal treatment in the intensive care unit, are placed on a high-priority list (HPL) for heart-lung transplantation (HLT) or double-lung transplantation (DLT). We assessed the effect of this approach on the waiting list and outcomes after transplantation.
METHODS
We conducted a single-center, retrospective, before-and-after study of consecutive patients with severe group 1, 1', or 4 PH listed for DLT or HLT between 2000 and 2013 (ie, 6 years before and 6 years after HPL implementation).
RESULTS
We included 234 patients. HPL implementation resulted in a significant decrease of the cumulative incidence of death on the waiting list at 1 and 2 years (p < 0.0001). The cumulative incidence of transplantation increased significantly from 48% to 76% after 2 years (p < 0.0001). Overall survival after transplantation was not significantly different between the pre-HPL and post-HPL era. In the HPL period, patients on the regular list who received a transplant had a nonsignificant trend toward improved overall survival compared with those on the HPL who received a transplant (at 1, 2, 3, and 5 years: 85%, 77%, 72%, and 72% vs 67%, 61%, 58%, and 50%; p = 0.053). Finally, survival after listing improved significantly after HPL implementation (at 1, 2, 3, and 5 years: 69%, 62%, 58%, and 54% vs 54%, 45%, 34%, and 26% before the HPL; p < 0.001).
CONCLUSIONS
HPL implementation was followed by higher survival of PH patients after registration on the DLT or HLT waiting list and by a higher cumulative incidence of transplantation among waiting-list patients.
背景
自2006年和2007年以来，法国患有严重肺动脉高压（PH）且尽管在重症监护病房接受了最佳治疗但仍面临死亡紧迫风险的患者，被列入心肺移植（HLT）或双肺移植（DLT）的高优先级名单（HPL）。我们评估了这种方法对等待名单和移植后结果的影响。
方法
我们对2000年至2013年期间（即HPL实施前6年和实施后6年）连续列入DLT或HLT名单的1、1'或4组严重PH患者进行了单中心回顾性前后对照研究。
结果
我们纳入了234例患者。HPL的实施导致等待名单上1年和2年时死亡的累积发生率显著降低（p < 0.0001）。2年后移植的累积发生率从48%显著增加到76%（p < 0.0001）。HPL实施前和实施后时代移植后的总体生存率无显著差异。在HPL期间，与接受移植的HPL患者相比，常规名单上接受移植的患者总体生存率有改善的非显著趋势（1、2、3和5年时：85%、77%、72%和72%对67%、61%、58%和50%；p = 0.053）。最后，HPL实施后列入名单后的生存率显著提高（1、2、3和5年时：69%、62%、58%和54%对HPL实施前的54%、45%、34%和26%；p < 0.001）。
结论
实施HPL后，PH患者在DLT或HLT等待名单登记后的生存率更高，等待名单患者的移植累积发生率也更高。
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