Wei Dong, Gao Fei, Wu Bo, Zhou Min, Zhang Ji, Yang Hang, Liu Dong, Fan Li, Chen Jingyu
Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China.
Department of Emergency, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China.
Clin Respir J. 2019 Jun;13(6):376-383. doi: 10.1111/crj.13020. Epub 2019 Apr 30.
Lung transplantation, either single or bilateral, serves as the only effective treatment for end-stage idiopathic pulmonary fibrosis (IPF), but their superiority is still being debated, and its application in Chinese patients has not been data analysed.
We reviewed 109 IPF patients who received lung transplantation at our centre between January 1, 2015 and December 31, 2017. The patients were divided into single lung transplantation (SLT) group and bilateral lung transplantation (BLT) group. We compared the two groups' demographic characteristics and clinical indexes (intraoperative conditions, postoperative complications, follow-ups and life qualities).
Patients in BLT group were significantly younger than those in SLT group (P < 0.001), and had more pretransplant infections (P = 0.007). The total ischemic time (P < 0.001) was shorter and intraoperative blood loss was less (P = 0.001) in SLT group. No significant difference was found in the proportion of patients in using anti-fibrosis drugs, pulmonary artery pressure, extracorporeal membrane oxygenation during the surgery; the length of intensive care unit stay; the incidence of complication; and the overall survival rate between two groups. However, the hierarchical analysis found that patients aged > 60 years showed a better survival in SLT group (P = 0.008). Both groups got normal MOS 36-item Short Form (SF-36) scores, and the scores of BLT were higher than those of SLT. The BLT group had better lung function than SLT group 1 year post-lung transplantation.
Both SLT and BLT are effective and SLT is more favourable for the patients of > 60 years.
单肺移植或双肺移植是终末期特发性肺纤维化（IPF）的唯一有效治疗方法，但其优势仍存在争议，且在中国患者中的应用尚未进行数据分析。
我们回顾了2015年1月1日至2017年12月31日期间在本中心接受肺移植的109例IPF患者。将患者分为单肺移植（SLT）组和双肺移植（BLT）组。我们比较了两组的人口统计学特征和临床指标（术中情况、术后并发症、随访及生活质量）。
BLT组患者明显比SLT组患者年轻（P<0.001），移植前感染更多（P=0.007）。SLT组的总缺血时间更短（P<0.001），术中失血量更少（P=0.001）。两组在使用抗纤维化药物的患者比例、肺动脉压、手术期间体外膜肺氧合；重症监护病房住院时间；并发症发生率；以及总体生存率方面未发现显著差异。然而，分层分析发现，年龄>60岁的患者在SLT组中生存率更高（P=0.008）。两组的MOS 36项简明健康调查问卷（SF-36）评分均正常，且BLT组的评分高于SLT组。肺移植术后1年，BLT组的肺功能优于SLT组。
SLT和BLT均有效，且SLT对年龄>60岁的患者更有利。
