Wilson-Smith Ashley R, Kim Yong Sul, Evans Georgina E, Yan Tristan D
The University of New South Wales, Medicine, Sydney, Australia.
The Collaborative Research Group (CORE), Macquarie University, Sydney, Australia.
Ann Cardiothorac Surg. 2020 Jan;9(1):10-19. doi: 10.21037/acs.2019.12.04.
Lung transplantation has long been the accepted therapy for end-stage pulmonary fibrotic disease. Presently, there is an ongoing debate over whether single or bilateral transplantation is the most appropriate treatment for end-stage disease, with a paucity of high-quality evidence comparing the two approaches head-to-head.
This review was performed in accordance with PRISMA recommendations and guidance. Searches were performed on PubMed Central, Scopus and Medline from dates of database inception to September 2019. For the assessed papers, data was extracted from the reviewed text, tables and figures, by two independent authors. Estimated survival was analyzed using the Kaplan-Meier method for studies where time-to-event data was provided.
Overall, 4,212 unique records were identified from the literature search. Following initial screening and the addition of reference list findings, 83 full-text articles were assessed for eligibility, of which 17 were included in the final analysis, with a total of 5,601 patients. Kaplan-Meier survival analysis illustrated improved survival in patients receiving bilateral lung transplantation (BLTx) than in those receiving unilateral transplantation for idiopathic pulmonary fibrosis at all time intervals, with aggregated survival for BLTx at 57%, 35.3% and 24% at 5-, 10- and 15-year follow-up, respectively. Survival rates for SLTx were 50%, 27.8% and 13.9%, respectively.
Whilst a number of studies present conflicting results with respect to short-term transplantation outcomes, BLTx confers improved long-term survival over SLTx, with large-scale registries supporting findings from single- and multi-center studies. Through an aggregation of published survival data, this meta-analysis identified improved survival in patients receiving BLTx versus SLTx at all time intervals.
长期以来，肺移植一直是终末期肺纤维化疾病公认的治疗方法。目前，关于单肺移植还是双肺移植是终末期疾病最合适的治疗方法存在争议，缺乏高质量的证据直接比较这两种方法。
本综述按照PRISMA建议和指南进行。从数据库建立之日至2019年9月在PubMed Central、Scopus和Medline上进行检索。对于评估的论文，由两名独立作者从审阅的文本、表格和图表中提取数据。对于提供了事件发生时间数据的研究，使用Kaplan-Meier方法分析估计生存率。
总体而言，通过文献检索共识别出4212条独特记录。经过初步筛选并补充参考文献列表中的发现后，对83篇全文文章进行了资格评估，其中17篇纳入最终分析，共涉及5601例患者。Kaplan-Meier生存分析表明，在所有时间间隔内，特发性肺纤维化患者接受双肺移植（BLTx）后的生存率均高于接受单肺移植的患者，双肺移植在5年、10年和15年随访时的累计生存率分别为57%、35.3%和24%。单肺移植（SLTx）的生存率分别为50%、27.8%和13.9%。
虽然一些研究在短期移植结果方面存在相互矛盾的结果，但双肺移植比单肺移植具有更好的长期生存率，大型登记研究支持单中心和多中心研究的结果。通过汇总已发表的生存数据，本荟萃分析发现，在所有时间间隔内，接受双肺移植的患者比接受单肺移植的患者生存率更高。
