扩展标准供体肺不影响儿科移植受者的结局。
Extended criteria donor lungs do not impact recipient outcomes in pediatric transplantation.
机构信息
Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Centre for Lung Research, BREATH site, Hannover, Germany.
Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
出版信息
J Heart Lung Transplant. 2019 May;38(5):560-569. doi: 10.1016/j.healun.2019.02.012. Epub 2019 Feb 27.
BACKGROUND
Pediatric lung transplantation remains the only curative treatment option for some end-stage lung diseases in childhood. Recipient numbers outnumber potential donor organs, and therefore a broader group of donor organs must be considered for pediatric lung transplantation. Herein we describe the outcome of utilizing extended criteria donor organs in pediatric lung transplantation.
METHODS
A retrospective analysis was performed on all pediatric lung transplantations performed at the Hannover Medical School between April 2010 and December 2016. Donors were assigned to a group fulfilling standard donor criteria (International Society for Heart and Lung Transplantation [ISHLT] 2003) or not. Recipients' early- and mid-term morbidity and mortality were recorded.
RESULTS
A total of 57 pediatric lung transplantations were performed: 27 donors fulfilled standard donor criteria (standard criteria donor [SCD] group) and 30 donors were extended criteria donors not fulfilling standard donor criteria (extended criteria donor [ECD] group). Pre-operative recipient characteristics, including age (median [IQR]: 14 [10‒15] vs 13 [10.8‒15] years, p = 0.71), underlying disease, admission to intensive care unit (37.0% vs 50%, p = 0.42), mechanical ventilation (14.8% vs 10.0%, p = 0.70), and extracorporeal membrane oxygenation (ECMO) support (11.1% vs 23.3%, p = 0.30) of both groups were similar. In the ECD group, more atypical volume reductions of the allograft were performed (0% vs 16.7%, p = 0.05), yet incidence of post-operative ECMO support was similar for the 2 groups. ECD recipients spent significantly less time on mechanical ventilation (median [IQR]: 2 [1‒2] vs 1 [1‒2] days, p = 0.04)] after surgery, but total intensive care unit stay and total hospital stay were similar between groups. Pulmonaryfunction testing results at discharge from initial hospital stay, after 1 year, and at last assessment were also similar. Freedom from chronic lung allograft dysfunction at 1 and 5years after transplantation showed no significant differences between groups. Survival rates up to 5years (67.9% vs 90.5%, p = 0.35) after transplantation were comparable between groups, yet, counterintuitively, long-term survival in the ECD group showed superior trends compared with the SCD group.
CONCLUSIONS
ECD lungs can be used safely for pediatric lung transplantation without compromising short- and mid-term results.
背景
小儿肺移植仍然是一些儿童终末期肺部疾病的唯一根治性治疗选择。受者数量超过潜在供体器官数量，因此必须考虑更广泛的供体器官群体用于小儿肺移植。本文描述了在小儿肺移植中使用扩展标准供体器官的结果。
方法
对 2010 年 4 月至 2016 年 12 月期间在汉诺威医学院进行的所有小儿肺移植进行回顾性分析。供体被分为符合标准供体标准（国际心肺移植协会[ISHLT]2003 年）的供体组或不符合标准供体标准的供体组。记录受体的早期和中期发病率和死亡率。
结果
共进行了 57 例小儿肺移植：27 例供体符合标准供体标准（标准供体[SCD]组），30 例供体为不符合标准供体标准的扩展标准供体（扩展标准供体[ECD]组）。两组受体的术前特征，包括年龄（中位数[IQR]：14 [10-15] 岁 vs 13 [10.8-15] 岁，p=0.71）、基础疾病、入住重症监护病房（37.0% vs 50%，p=0.42）、机械通气（14.8% vs 10.0%，p=0.70）和体外膜氧合（ECMO）支持（11.1% vs 23.3%，p=0.30）相似。在 ECD 组中，进行了更多的同种异体肺体积缩小（0% vs 16.7%，p=0.05），但两组术后 ECMO 支持的发生率相似。ECD 受体手术后在机械通气上花费的时间显著减少（中位数[IQR]：2 [1-2] 天 vs 1 [1-2] 天，p=0.04），但两组的重症监护病房总住院时间和总住院时间相似。初次住院、1 年和最后评估时的肺功能测试结果也相似。移植后 1 年和 5 年无慢性肺移植物功能障碍的生存率在两组之间无显著差异。移植后 5 年的生存率（67.9% vs 90.5%，p=0.35）在两组之间也相似，但令人意外的是，ECD 组的长期生存率显示出优于 SCD 组的趋势。
结论
ECD 肺可安全用于小儿肺移植，而不会影响短期和中期结果。
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