肺移植治疗不可逆转的急性呼吸窘迫综合征。
Lung transplantation for the treatment of irreversible acute respiratory distress syndrome.
机构信息
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
Clin Transplant. 2021 Feb;35(2):e14182. doi: 10.1111/ctr.14182. Epub 2020 Dec 15.
BACKGROUND
Despite advances in critical care for acute respiratory distress syndrome (ARDS), some survivors in the acute phase are unable to wean from extracorporeal membrane oxygenation (ECMO) or mechanical ventilation. To date, little is known regarding whether lung transplantation confers a survival benefit for irreversible ARDS.
METHODS
This retrospective study was conducted using the United Network for Organ Sharing database (May 2005-December 2018). Patients with restrictive lung disease were divided into two groups: patients with and without ARDS. Propensity score matching identified recipients without ARDS for the control group.
RESULTS
A total of 63 patients with ARDS were waitlisted for lung transplantation, while 39 received a lung transplant after a median waitlist duration of 8 days. Seventy-eight patients were matched as controls. In the ARDS group, the median age was 30 years, and the median lung allocation score was 88.4. Among the 39 recipients, 30 (76.9%) received ECMO support prior to transplantation. Lung transplantation for ARDS and restrictive lung disease showed similar 90-day (87.2% vs. 88.5%, p = .80), 1-year (82.1% vs. 85.9%, p = .52), and 3-year (69.2% vs. 65.4%, p = .94) survival rates.
CONCLUSIONS
Lung transplantation provides acceptable outcomes in selected patients with irreversible ARDS.
背景
尽管急性呼吸窘迫综合征（ARDS）的重症监护取得了进展，但一些急性期的幸存者仍无法脱离体外膜氧合（ECMO）或机械通气。迄今为止，对于不可逆性 ARDS 患者，肺移植是否能带来生存获益，知之甚少。
方法
本回顾性研究使用了 United Network for Organ Sharing 数据库（2005 年 5 月至 2018 年 12 月）。将患有限制性肺病的患者分为两组：有 ARDS 组和无 ARDS 组。采用倾向评分匹配法为对照组确定无 ARDS 的患者。
结果
共有 63 名 ARDS 患者等待肺移植，中位等待时间为 8 天，其中 39 名患者在等待后接受了肺移植。另外匹配了 78 名患者作为对照组。在 ARDS 组中，患者的中位年龄为 30 岁，中位肺分配评分 88.4。在 39 名接受者中，有 30 名（76.9%）在移植前接受 ECMO 支持。对于 ARDS 和限制性肺病患者，肺移植后的 90 天（87.2% vs. 88.5%，p=0.80）、1 年（82.1% vs. 85.9%，p=0.52）和 3 年（69.2% vs. 65.4%，p=0.94）生存率相似。
结论
对于选定的不可逆性 ARDS 患者，肺移植可提供可接受的结果。
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