肺移植后闭塞性细支气管炎综合征无复发生存：国际心肺移植学会胸科移植登记分析。
Bronchiolitis obliterans syndrome-free survival after lung transplantation: An International Society for Heart and Lung Transplantation Thoracic Transplant Registry analysis.
机构信息
Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Divisions of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
United Network for Organ Sharing, Richmond, Virginia; International Society for Heart and Lung Transplantation, Dallas, Texas.
出版信息
J Heart Lung Transplant. 2019 Jan;38(1):5-16. doi: 10.1016/j.healun.2018.09.016. Epub 2018 Sep 25.
BACKGROUND
Lung transplant (LTx) recipients have low long-term survival and a high incidence of bronchiolitis obliterans syndrome (BOS). However, few long-term, multicenter, and precise estimates of BOS-free survival (a composite outcome of death or BOS) incidence exist.
METHODS
This retrospective cohort study of primary LTx recipients (1994-2011) reported to the International Society of Heart and Lung Transplantation Thoracic Transplant Registry assessed outcomes through 2012. For the composite primary outcome of BOS-free survival, we used Kaplan-Meier survival and Cox proportional hazards regression, censoring for loss to follow-up, end of study, and re-LTx. Although standard Thoracic Transplant Registry analyses censor at the last consecutive annual complete BOS status report, our analyses allowed for partially missing BOS data.
RESULTS
Due to BOS reporting standards, 99.1% of the cohort received LTx in North America. During 79,896 person-years of follow-up, single LTx (6,599 of 15,268 [43%]) and bilateral LTx (8,699 of 15,268 [57%]) recipients had a median BOS-free survival of 3.16 years (95% confidence interval [CI], 2.99-3.30 years) and 3.58 years (95% CI, 3.53-3.72 years), respectively. Almost 90% of the single and bilateral LTx recipients developed the composite outcome within 10 years of transplantation. Standard Registry analyses "overestimated" median BOS-free survival by 0.42 years and "underestimated" the median survival after BOS by about a half-year for both single and bilateral LTx (p < 0.05).
CONCLUSIONS
Most LTx recipients die or develop BOS within 4 years, and very few remain alive and free from BOS at 10 years post-LTx. Less inclusive Thoracic Transplant Registry analytic methods tend to overestimate BOS-free survival. The Registry would benefit from improved international reporting of BOS and other chronic lung allograft dysfunction (CLAD) events.
背景
肺移植（LTx）受者的长期生存率较低，且发生细支气管闭塞性综合征（BOS）的概率较高。然而，目前关于 BOS 无生存（死亡或 BOS 的复合结局）的长期、多中心和精确估计数据较少。
方法
本研究回顾性分析了国际心肺移植协会胸外科移植登记处（1994-2011 年）报告的原发性 LTx 受者，截至 2012 年评估其结果。对于 BOS 无生存的复合主要结局，我们使用 Kaplan-Meier 生存和 Cox 比例风险回归，对随访丢失、研究结束和再次 LTx 进行删失。尽管标准的胸外科移植登记处分析在最后一次连续完整的 BOS 状态报告时进行删失，但我们的分析允许部分缺失 BOS 数据。
结果
由于 BOS 报告标准，该队列中的 99.1%的受者在美国接受 LTx。在 79896 人年的随访期间，单肺 LTx（15268 例中的 6599 例[43%]）和双肺 LTx（15268 例中的 8699 例[57%]）受者的中位 BOS 无生存时间分别为 3.16 年（95%置信区间[CI]，2.99-3.30 年）和 3.58 年（95% CI，3.53-3.72 年）。几乎 90%的单肺和双肺 LTx 受者在移植后 10 年内发生了复合结局。标准登记处分析“高估”了单肺和双肺 LTx 的中位 BOS 无生存时间，分别高估了 0.42 年和大约半年（p<0.05）。
结论
大多数 LTx 受者在 4 年内死亡或发生 BOS，很少有受者在 LTx 后 10 年内仍然存活且无 BOS。不那么全面的胸外科移植登记处分析方法往往会高估 BOS 无生存时间。登记处将受益于改善 BOS 和其他慢性肺移植物功能障碍（CLAD）事件的国际报告。
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