Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 2018 Sep;106(3):856-863. doi: 10.1016/j.athoracsur.2018.04.060. Epub 2018 May 24.
Double-lung transplantation (DLT) has better long-term outcomes compared with single-lung transplantation (SLT) in pulmonary fibrosis. However, controversy persists about whether older patients or patients with high lung allocation scores would benefit from DLT. Moreover, the degree of pulmonary hypertension in which SLT should be avoided is unknown.
A retrospective analysis using the United Network for Organ Sharing database was performed in all recipients of lung transplants for pulmonary fibrosis. Kaplan-Meier survival for SLT versus DLT was compared and stratified by age, allocation score, and mean pulmonary artery pressure. Cox regression and propensity-matching analyses were performed.
Between 1987 and 2015; 9,191 of 29,779 lung transplants were performed in pulmonary fibrosis. Ten-year survival rates were 55% for DLT and 32% for SLT (p < 0.001). When stratified by age, DLT recipients had improved survival at all age cutoffs, except age ≥70 years. In addition, DLT recipients had improved survival across all lung allocation scores (<45, ≥45, ≥60, ≥75) and all pulmonary artery pressure categories (<25, ≥25, ≥30, ≥40 mm Hg). Among DLT recipients, pulmonary artery pressure and allocation score did not affect survival. Among SLT recipients, a pressure ≥25 mm Hg did not influence survival. Conversely, patients with a pressure ≥30 mm Hg and an allocation score ≥45 had decreased survival. On Cox regression and on propensity matching, DLT had improved survival compared with SLT.
In pulmonary fibrosis, DLT has improved survival compared with SLT and should be considered the procedure of choice in patients younger than 70 years of age. SLT in patients with mean pulmonary artery pressure ≥30 mm Hg and an allocation score ≥45 should be discouraged.
与单肺移植（SLT）相比，双肺移植（DLT）在肺纤维化患者中具有更好的长期预后。然而，关于年龄较大的患者或肺分配评分较高的患者是否会从 DLT 中受益，仍存在争议。此外，尚不清楚应避免 SLT 的肺动脉高压程度。
使用器官共享联合网络数据库对所有肺纤维化接受者进行回顾性分析。比较并分层分析 Kaplan-Meier 生存曲线，分层因素包括年龄、分配评分和平均肺动脉压。进行 Cox 回归和倾向匹配分析。
1987 年至 2015 年期间，29779 例肺移植中有 9191 例肺纤维化患者。10 年生存率分别为 DLT 组 55%和 SLT 组 32%（p < 0.001）。按年龄分层，除年龄≥70 岁外，DLT 组在所有年龄截点均有更好的生存。此外，在所有肺分配评分（<45、≥45、≥60、≥75）和所有肺动脉压分类（<25、≥25、≥30、≥40mmHg）中，DLT 组均有更好的生存。在 DLT 组中，肺动脉压和分配评分均不影响生存。在 SLT 组中，压力≥25mmHg 不影响生存。相反，压力≥30mmHg 和分配评分≥45 的患者生存时间缩短。在 Cox 回归和倾向匹配中，DLT 组的生存时间优于 SLT 组。
在肺纤维化中，与 SLT 相比，DLT 可改善生存，因此对于年龄小于 70 岁的患者应考虑作为首选方案。对于平均肺动脉压≥30mmHg 和分配评分≥45 的患者，应避免进行 SLT。
