Toronto Lung Transplant Program, Division of Thoracic Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Toronto Lung Transplant Program, Division of Thoracic Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2021 May;161(5):1674-1685. doi: 10.1016/j.jtcvs.2020.04.166. Epub 2020 May 23.
Lobar lung transplantation (LLTx) from deceased donors is a potential solution for donor-recipient size mismatch for small sized recipients. We reviewed our institutional experience to compare outcomes after LLTx to standard lung transplantation (LTx).
We retrospectively reviewed transplants in our institution from January 2000 to December 2017. LLTx early- and long-term outcomes were compared with LTx. Additional analysis of outcomes was performed after dividing the cohort into 2 eras (era 1, 2000-2012; era 2, 2013-2017).
Among the entire cohort (1665), 75 were LLTx (4.5%). Compared with LTx, LLTx were more frequently bridged to transplant with extracorporeal life support or mechanical ventilation and were transplanted in a rapidly deteriorating status (respectively, 20% vs 4.4%, P = .001; 22.7% vs 7.9, P < .001; and 41.3% vs 26.5%, P = .013). LLTx had longer intensive care unit and hospital lengths of stay (respectively, median 17 vs 4 days, and 45 vs 23, both P < .001), and greater 30-day mortality (13.3% vs 4.3%, P = .001) and 90-day mortality (17.3% vs 7.2%, P = .003). In era 2, despite a significantly greater 30-day mortality (10.8% vs 2.8%, P = .026), there was no significant difference in 90-day mortality between LLTx and LTx (13.5% vs 5.1%, P = .070). Overall survival at 1, 3, and 5 years was not significantly different between LLTx and LTx (73.2% vs 84.4%, 56.9% vs 68.4% and 50.4% vs 55.8, P = .088).
Although LLTx is a high-risk procedure, both mid- and long-term survival are comparable with LTx in all cohorts in the modern era. LLTx therefore represents a valuable surgical option for small-sized recipients.
对于体型较小的受者，来自已故供者的肺叶移植（LLTx）是解决供受者体型不匹配的潜在方法。我们回顾了本机构的经验，比较了 LLTx 与标准肺移植（LTx）的结果。
我们回顾性分析了本机构 2000 年 1 月至 2017 年 12 月期间的移植病例。将 LLTx 的早期和长期结果与 LTx 进行比较。在将队列分为 2 个时期（时期 1，2000-2012 年；时期 2，2013-2017 年）后，对结果进行了额外分析。
在整个队列（1665 例）中，75 例行 LLTx（4.5%）。与 LTx 相比，LLTx 更常通过体外生命支持或机械通气桥接移植，并且在病情迅速恶化的情况下进行移植（分别为 20%比 4.4%，P=0.001；22.7%比 7.9%，P<0.001；和 41.3%比 26.5%，P=0.013）。LLTx 的重症监护病房和住院时间更长（分别为中位数 17 天比 4 天和 45 天比 23 天，均 P<0.001），30 天死亡率更高（13.3%比 4.3%，P=0.001）和 90 天死亡率（17.3%比 7.2%，P=0.003）。在时期 2，尽管 30 天死亡率显著升高（10.8%比 2.8%，P=0.026），但 LLTx 和 LTx 之间 90 天死亡率无显著差异（13.5%比 5.1%，P=0.070）。1、3 和 5 年的总体生存率在 LLTx 和 LTx 之间无显著差异（73.2%比 84.4%，56.9%比 68.4%和 50.4%比 55.8%，P=0.088）。
尽管 LLTx 是一种高风险的手术，但在现代时代的所有队列中，其中期和长期生存率均与 LTx 相当。因此，LLTx 是一种对体型较小的受者有价值的手术选择。
