Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo Hospital, Tokyo, Japan; Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
J Thorac Cardiovasc Surg. 2020 Feb;159(2):720-730.e6. doi: 10.1016/j.jtcvs.2019.07.087. Epub 2019 Aug 25.
Ex vivo lung perfusion (EVLP) is reportedly a useful strategy that permits marginal donor lungs to be evaluated and reconditioned for successful lung transplantation (LTx). This systematic review and meta-analysis was performed to evaluate the outcomes of EVLP conducted for marginal donor lungs.
We searched PubMed, the Cochrane Library, and Embase to select studies describing the results of LTx following EVLP for marginal donor lungs compared with standard LTx without EVLP. We performed a meta-analysis to examine donor baseline characteristics, recipient baseline characteristics, and postoperative outcomes.
Of 1380 studies, 8 studies involving 1191 patients met the inclusion criteria. Compared with the non-EVLP group (ie, standard LTx without EVLP), the EVLP group (ie, EVLP of marginal donors following LTx) had similar donor age and sex and recipient baseline age, sex, body mass index, bridge by ventilator/extracorporeal life support/extracorporeal membrane oxygenation, and rate of double LTx but more abnormal donor lung radiographs (P = .0002), a higher smoking history rate (P = .03), and worse donor arterial oxygen tension/inspired oxygen fraction (P < .00001). However, there were no significant differences in outcomes between the EVLP and non-EVLP groups with respect to the length of postoperative intubation, postoperative extracorporeal life support/extracorporeal membrane oxygenation use, length of intensive care unit stay, length of hospital stay, 72-hour primary graft dysfunction of grade 3, 30-day survival, or 1-year survival (all P values > .05).
Posttransplant outcomes were similar between EVLP-treated LTx and standard LTx without EVLP, although the quality of donor lungs was worse with EVLP-treated LTx.
据报道，体外肺灌注（EVLP）是一种有用的策略，可用于评估和修复边缘供体肺，以实现成功的肺移植（LTx）。本系统评价和荟萃分析旨在评估 EVLP 治疗边缘供体肺的结果。
我们检索了 PubMed、Cochrane 图书馆和 Embase，以选择描述与未行 EVLP 的标准 LTx 相比，行 EVLP 治疗的边缘供体肺的 LTx 结果的研究。我们进行了荟萃分析，以检查供体基线特征、受体基线特征和术后结果。
在 1380 项研究中，有 8 项研究涉及 1191 名患者符合纳入标准。与非 EVLP 组（即未行 EVLP 的标准 LTx）相比，EVLP 组（即 LTx 后行 EVLP 治疗的边缘供体）的供体年龄和性别以及受体基线年龄、性别、体重指数、呼吸机/体外生命支持/体外膜氧合桥接以及双肺移植率相似，但供体肺部 X 线片更异常（P=0.0002）、吸烟史发生率更高（P=0.03）、供体动脉氧分压/吸入氧分数更差（P<0.00001）。然而，EVLP 组与非 EVLP 组在术后插管时间、术后体外生命支持/体外膜氧合使用、重症监护病房住院时间、住院时间、72 小时原发性移植物功能障碍 3 级、30 天存活率或 1 年存活率方面，术后结果无显著差异（所有 P 值均>0.05）。
尽管 EVLP 治疗的 LTx 供体肺质量较差，但 EVLP 治疗的 LTx 与未行 EVLP 的标准 LTx 相比，移植后结果相似。
