Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Pulmonology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Scand Cardiovasc J. 2020 Jun;54(3):192-199. doi: 10.1080/14017431.2020.1726444. Epub 2020 Mar 9.
Lung transplantation remains the only available treatment option for many end-stage lung diseases. We evaluated our long-term lung transplantation results and the impact of chronic lung allograft dysfunction (CLAD). Adult lung transplants (2003-2015, =175) in a nationwide single transplant center were retrospectively analyzed. Kaplan-Meier survival and Cox regression analysis were used to evaluate the effect of CLAD. Recipient and graft 1-, 5- and 10-year survival estimates were 94%, 79% and 64%, and 93%, 75% and 59%, respectively. CLAD affected 43% of patients at a median of 2.3 years after transplantation, and impaired recipient ( = .03) and graft survival ( = .001) with the most advanced CLAD stage, and restrictive CLAD phenotype, resulting in worst graft survival. CLAD was the primary cause of death in 54% of all patients, and in 80% of patients with an established CLAD diagnosis. CLAD, high-risk cytomegalovirus serostatus, and recipient preoperative sensitization increased graft loss hazard ratio. CLAD was the only significant investigated risk factor for graft loss in multivariate regression analysis. Although very favourable lung transplant patient long-term survival was achieved, CLAD significantly impaired recipient and graft survival. Identification of risk factors and therapeutic options for CLAD may further improve lung transplantation results.
肺移植仍然是许多终末期肺部疾病的唯一可行治疗选择。我们评估了我们的长期肺移植结果以及慢性肺移植物功能障碍（CLAD）的影响。在全国性的单一移植中心回顾性分析了成人肺移植（2003-2015 年，=175）。使用 Kaplan-Meier 生存和 Cox 回归分析评估 CLAD 的影响。受者和移植物 1、5 和 10 年生存率估计分别为 94%、79%和 64%和 93%、75%和 59%。CLAD 在移植后中位数为 2.3 年时影响 43%的患者，并且在最先进的 CLAD 阶段和限制性 CLAD 表型中损害受者（ = .03）和移植物的生存（ = .001），导致移植物的生存最差。CLAD 是所有患者死亡的主要原因（54%），也是确诊 CLAD 患者死亡的主要原因（80%）。CLAD、高风险巨细胞病毒血清状态和受者术前致敏增加了移植物丢失风险比。CLAD 是多变量回归分析中唯一有意义的移植物丢失的调查危险因素。虽然实现了非常有利的肺移植患者长期生存，但 CLAD 显著损害了受者和移植物的生存。确定 CLAD 的危险因素和治疗选择可能会进一步改善肺移植的结果。
