Prudencio-Ribera V C, Corral-Blanco M, Jarrín-Estupiñán M E, Alonso-Moralejo R, Pérez-González V, Martínez-Serna I, González-Serrano M, De Pablo-Gafas A
Department of Respiratory Medicine, Transplant Unit Hospital Universitario 12 de Octubre, Madrid, Spain.
Department of Respiratory Medicine, Transplant Unit Hospital Universitario 12 de Octubre, Madrid, Spain.
Transplant Proc. 2019 Mar;51(2):372-375. doi: 10.1016/j.transproceed.2018.10.020. Epub 2018 Oct 30.
Patients with diffuse parenchymal lung disease (DPLD) have the poorest survival rates both before and after lung transplantation (LT). Early mortality among LT patients as a result of DLPD is estimated at 10% to 20%. The aim of the study was to assess intrahospital mortality after LT procedures for DLPD and to identify factors in the recipient, donor, intra- and postoperative periods that might improve early outcomes.
A retrospective, observational, cohort, single-hospital study was conducted. Data from 67 patients with LT patients owing to DPLD were recorded between October 2008 to June 2017 in Madrid, Spain.
Out of 67 LT recipients with DPLD, 51 had idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP), 6 nonspecific interstitial pneumonia (NSIP), and 10 other DPLD. Intrahospital mortality took place in 13.4% of patients, with a median survival time of 34 days (interquartile range [IQR], 27.50-66). In the preoperative period, there were no differences in the recipients' demographic and hemodynamic characteristics, respiratory function, or time spent in the waiting list, except higher doses of systemic steroids in nonsurvivors (prednisone 15 vs 10 mg, P = .046). No differences were reported in the donors' characteristics (age, mechanical ventilation hours, PaO/FiO). In the intraoperative and postoperative periods, we found differences statistically significant in longer cold ischemia time and development of primary graft dysfunction (PGD) grade 3 in the nonsurvivor group.
The mortality rate in our series was 13.4%, and the main risk factors for intrahospital mortality were longer cold ischemia time and greater incidence of PGD grade 3.
弥漫性实质性肺疾病（DPLD）患者在肺移植（LT）前后的生存率最低。因DPLD导致的LT患者早期死亡率估计为10%至20%。本研究的目的是评估DPLD患者LT术后的院内死亡率，并确定受者、供者、术中和术后可能改善早期预后的因素。
进行了一项回顾性、观察性、队列、单中心医院研究。2008年10月至2017年6月期间，在西班牙马德里记录了67例因DPLD接受LT的患者的数据。
在67例DPLD的LT受者中，51例患有特发性肺纤维化（IPF）/普通间质性肺炎（UIP），6例为非特异性间质性肺炎（NSIP），10例为其他DPLD。13.4%的患者发生院内死亡，中位生存时间为34天（四分位间距[IQR]，27.50 - 66）。术前，除了非存活者使用更高剂量的全身类固醇（泼尼松15 mg对10 mg，P = 0.046）外，受者的人口统计学和血流动力学特征、呼吸功能或等待名单上的时间没有差异。供者特征（年龄、机械通气时间、PaO/FiO）无差异。在术中和术后，我们发现非存活者组冷缺血时间更长和发生3级原发性移植物功能障碍（PGD）具有统计学显著差异。
我们系列研究中的死亡率为13.4%，院内死亡的主要危险因素是冷缺血时间更长和3级PGD的发生率更高。
