Blitzer David, Copeland Hannah, Roe David, Hage Chadi, Wang I-Wen, Duncan Michael, Manghelli Joshua, Gooch Danyel, Wozniak Thomas
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Cardiac Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi.
J Card Surg. 2020 Feb;35(2):273-278. doi: 10.1111/jocs.14163. Epub 2019 Aug 7.
There are approximately 2000 lung transplants performed across the United States annually. There is limited data to identify factors predictive of long-term survival.
We evaluated 10-year survivors after lung transplant to determine predictors of long-term survival.
Data were collected from the United Network for Organ Sharing registry database from a single institution. Inclusion criteria were: patients who received a lung transplant between 1989 and 2005. Descriptive statistics were calculated, and survival outcomes were analyzed using the Kaplan-Meier method.
Three hundred sixty-one patients received a lung transplant between 1989 and 2005, and 77 patients survived at least 10 years (21%). Diagnoses at the time of transplant included: chronic obstructive pulmonary disease/emphysema 45 (58.4%), idiopathic pulmonary fibrosis 12 (15.6%), alpha 1 anti-trypsin deficiency 6 (7.8%), cystic fibrosis 4 (5.2%), primary pulmonary hypertension 2 (2.6%), and Eisenmenger's syndrome 1 (1.3%). Seventy-four recipients (96.10%) were Caucasian; 46 (59.74%) were female. Age at the time of transplant ranged from 19 to 67 years (mean 50.8; median 52). Forty-two patients (54.5%) were double lung recipients. Survival ranged from 10.0 to 21.9 years (mean 15.5y; median 15.48y). Forty-two (54.5%) subjects are currently alive; the most common causes of death included: chronic rejection (20%), and infection (17.14%).
Ten-year survivors were significantly younger, weighed less, and had significantly shorter lengths of hospitalization after transplantation. Bilateral lung transplantation was a significant factor in prolonged survival. Survival also improved with institutional experience.
美国每年约进行2000例肺移植手术。目前用于识别长期生存预测因素的数据有限。
我们评估了肺移植术后10年存活者，以确定长期生存的预测因素。
数据来自单一机构的器官共享联合网络登记数据库。纳入标准为：1989年至2005年间接受肺移植的患者。计算描述性统计数据，并使用Kaplan-Meier方法分析生存结果。
1989年至2005年间，361例患者接受了肺移植，77例患者存活至少10年（21%）。移植时的诊断包括：慢性阻塞性肺疾病/肺气肿45例（58.4%）、特发性肺纤维化12例（15.6%）、α1抗胰蛋白酶缺乏症6例（7.8%）、囊性纤维化4例（5.2%）、原发性肺动脉高压2例（2.6%）、艾森曼格综合征1例（1.3%）。74名受者（96.10%）为白种人；46名（59.74%）为女性。移植时年龄在19至67岁之间（平均50.8岁；中位数52岁）。42例患者（54.5%）接受了双肺移植。生存时间为10.0至21.9年（平均15.5年；中位数15.48年）。42名（54.5%）受试者目前仍存活；最常见的死亡原因包括：慢性排斥反应（20%）和感染（17.14%）。
10年存活者明显更年轻、体重更轻，移植后住院时间明显更短。双侧肺移植是延长生存的重要因素之一。随着机构经验的增加，生存率也有所提高。
