Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplantation. 2018 May;102(5):829-837. doi: 10.1097/TP.0000000000002004.
Lung transplantation (LTPL) is considered as a salvage therapeutic option in patients with end-stage lung disease. However, there is a lack of sufficient data on the use of LTPL in patients with acute respiratory distress syndrome (ARDS). Although there are few case reports on lung transplant for ARDS, no case series exists up to date. The aim of this study was to evaluate the clinical outcomes of patients with ARDS in accordance with the LTPL status.
Patients who had severe ARDS (PaO2/FiO2 ratio ≤ 100 mm Hg with positive end-expiratory pressure ≥ 5 cm H2O) and were listed for LTPL with no underlying end-stage lung disease were included in this single-center retrospective study. Demographic and clinical data of the patients were collected and analyzed.
Fourteen patients were listed for LTPL due to severe ARDS. All patients received mechanical ventilation, and 12 (86%) patients underwent extracorporeal membrane oxygenation. Of the 9 patients who underwent LTPL, 8 (89%) survived, whereas only 1 (20%) patient out of those who did not receive LTPL survived. The median survival time of the patients who underwent LTPL was 1996 days (interquartile range [IQR], 872-2239), compared with 49 days (IQR, 872-2239) in patients who did not undergo LTPL. The median survival time after LTPL was 64 months (IQR, 28-72). The 3-year survival rate of the recipients was 78%.
LTPL may be considered as a therapeutic option in a select group of patients with severe ARDS. However, the irreversibility of the patient's lung status should be considered.
肺移植（LTPL）被认为是终末期肺病患者的一种挽救性治疗选择。然而，在急性呼吸窘迫综合征（ARDS）患者中使用 LTPL 的数据不足。尽管有少数关于 ARDS 肺移植的病例报告，但迄今为止尚无病例系列。本研究旨在评估根据 LTPL 状态的 ARDS 患者的临床结局。
这项单中心回顾性研究纳入了患有严重 ARDS（呼气末正压≥5cmH2O 时，氧分压/吸入氧分数比≤100mmHg）且没有潜在终末期肺病而被列入 LTPL 名单的患者。收集并分析了患者的人口统计学和临床数据。
14 名患者因严重 ARDS 而被列入 LTPL 名单。所有患者均接受机械通气，12 名（86%）患者接受体外膜氧合。在接受 LTPL 的 9 名患者中，8 名（89%）存活，而未接受 LTPL 的患者中只有 1 名（20%）存活。接受 LTPL 的患者的中位生存时间为 1996 天（四分位距 [IQR]，872-2239），而未接受 LTPL 的患者的中位生存时间为 49 天（IQR，872-2239）。LTPL 后的中位生存时间为 64 个月（IQR，28-72）。受者的 3 年生存率为 78%。
LTPL 可被视为一组严重 ARDS 患者的治疗选择。然而，应考虑患者肺部状况的不可逆性。
