Ren Dewei, Kaleekal Thomas S, Graviss Edward A, Nguyen Duc T, Sinha Neeraj, Goodarzi Amad, Agboli Isioma, Suarez Erik E, Loebe Matthias, Scheinin Scott A, Bruckner Brian A
DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX.
Pulmonary and Critical Care, Houston Methodist Hospital, Houston, TX.
Transplant Direct. 2018 Oct 25;4(11):e404. doi: 10.1097/TXD.0000000000000844. eCollection 2018 Nov.
With the increase of primary lung transplantation across major centers worldwide, over the last several years the need of lung retransplant (ReTX) is likely to increase. Therefore, characterization of ReTX patients is prudent and necessary. Our study aimed to investigate and characterize the covariates and outcomes associated with lung ReTX survival in a single large U.S. transplant center.
Demographic, clinical diagnoses, and comorbidities were analyzed. Kaplan-Meier statistics were used to calculate and predict survival for 30 days and up to 3 years. Cox proportional modeling was used to determine the variables associated with mortality.
Of included 684 lung transplants performed at the Houston Methodist Hospital between January 2009 and December 2015, 49 were lung ReTX. Median age of primary lung transplant (non-ReTX) and ReTx recipients was 62 and 49 years, respectively. Chronic graft rejection in the form of restrictive chronic lung allograft dysfunction and bronchiolitis obliterans syndrome was the main indications for ReTX. Compared with non-ReTX patients, ReTX patients had higher median lung allocation score (46.2 vs 37.0, respectively) and higher mortality after 6 months posttransplant. ReTX, older age, female sex, hospitalization 15 days or longer, estimated glomerular filtration rate less than 60, 6-minute walk distance less than 400 ft, and donor/recipient height ratio less than 1 were significantly associated with decreased 1-year patient and graft survival. Chronic graft rejection was still the major cause of death in the long-term follow-up recipients.
Our findings suggested that lung ReTX recipients have poor long-term survival outcomes. Lung ReTX should only be offered to carefully selected patients.
随着全球各大中心原发性肺移植数量的增加，在过去几年中，肺再次移植（ReTX）的需求可能也会增加。因此，对再次移植患者进行特征描述是谨慎且必要的。我们的研究旨在调查和描述美国一个大型移植中心与肺再次移植生存相关的协变量和结果。
分析了人口统计学、临床诊断和合并症。采用Kaplan-Meier统计方法计算和预测30天及长达3年的生存率。使用Cox比例模型确定与死亡率相关的变量。
在2009年1月至2015年12月期间于休斯顿卫理公会医院进行的684例肺移植中，有49例为肺再次移植。原发性肺移植（非再次移植）和再次移植受者的中位年龄分别为62岁和49岁。以限制性慢性肺移植功能障碍和闭塞性细支气管炎综合征形式出现的慢性移植排斥是再次移植的主要指征。与非再次移植患者相比，再次移植患者的中位肺分配评分更高（分别为46.2和37.0），且移植后6个月后的死亡率更高。再次移植、年龄较大、女性、住院15天或更长时间、估计肾小球滤过率低于60、6分钟步行距离小于400英尺以及供体/受体身高比小于1与1年患者和移植物生存率降低显著相关。慢性移植排斥仍是长期随访受者的主要死亡原因。
我们的研究结果表明，肺再次移植受者的长期生存结果较差。肺再次移植应仅提供给经过精心挑选的患者。
