Rudym Darya, Benvenuto Luke, Costa Joseph, Aversa Meghan, Robbins Hilary, Shah Lori, Kim Hanyoung, Stanifer Bryan P, Sonett Joshua, D'Ovidio Frank, Arcasoy Selim M
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Ann Transplant. 2020 Aug 18;25:e922641. doi: 10.12659/AOT.922641.
BACKGROUND Morbidity and mortality rates after lung transplantation remain high compared to other solid organ transplants. In the lung allocation score era, patients given the highest priority on the waitlist are those with the greatest severity of illness, who often require preoperative hospitalization. MATERIAL AND METHODS To determine the association of pre-transplant hospitalization with post-transplant outcomes, we retrospectively evaluated 448 lung transplant recipients at our center between January 2010 and July 2017 (114 hospitalized; 334 outpatient). RESULTS Survival was similar between the groups (hazard ratio 0.93 [95% CI 0.61 to 1.42], p=0.738). However, hospitalized patients had longer hospital and intensive care unit length of stay compared to outpatients - 25 vs. 18 days, (p<0.001) and 9.5 vs. 6 days, (p<0.001), respectively. Hospitalized patients had higher rates of Grade 3 primary graft dysfunction - 29.8% vs. 9.6%, p<0.001 - and remained mechanically ventilated longer - 6 vs. 3 days, p<0.001. A greater percentage of hospitalized patients needed a tracheostomy and a re-operation within 30 days - 39.5% vs. 15.3% (p<0.001) and 22.8% vs. 12.0% (p=0.005) - respectively. After discharge, 28% of hospitalized patients required acute rehabilitation compared with 12% of outpatients (p=0.001). CONCLUSIONS While pre-transplant hospitalization is not associated with mortality, it is associated with significant morbidity after transplant.
背景 与其他实体器官移植相比，肺移植后的发病率和死亡率仍然很高。在肺分配评分时代，等待名单上优先级最高的患者是病情最严重的患者，他们通常需要术前住院治疗。材料与方法 为了确定移植前住院与移植后结局之间的关联，我们回顾性评估了2010年1月至2017年7月期间在我们中心接受肺移植的448例患者（114例住院；334例门诊）。结果 两组患者的生存率相似（风险比0.93 [95%可信区间0.61至1.42]，p = 0.738）。然而，与门诊患者相比，住院患者的住院时间和重症监护病房住院时间更长，分别为25天对18天（p < 0.001）和9.5天对6天（p < 0.001）。住院患者发生3级原发性移植物功能障碍的发生率更高，分别为29.8%对9.6%，p < 0.001，机械通气时间也更长，分别为6天对3天，p < 0.001。住院患者中有更大比例的人在30天内需要气管切开术和再次手术，分别为39.5%对15.3%（p < 0.001）和22.8%对12.0%（p = 0.005）。出院后，28%的住院患者需要急性康复治疗，而门诊患者为12%（p = 0.001）。结论 虽然移植前住院与死亡率无关，但与移植后的显著发病率有关。
