Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA.
Pediatr Transplant. 2021 Aug;25(5):e13951. doi: 10.1111/petr.13951. Epub 2021 Jan 6.
Plastic bronchitis is a rare post-Fontan complication with limited treatment options. Heart transplantation has evolved as a potential curative option, but outcomes have not been well-defined. This study aims to assess contemporary waitlist and post-transplant outcomes in patients with plastic bronchitis. All Fontan patients were identified in the PHTS database (2010 - 2018). Waitlist and post-transplant outcomes were compared between Fontan patients with and without plastic bronchitis. Competing outcomes and Kaplan-Meier analyses were used to assess the impact of plastic bronchitis on waitlist and post-transplant survival. A secondary analysis excluded those with PLE from the comparison cohort. Of 645 Fontan patients listed for heart transplant, 69 (11%) had plastic bronchitis. At listing, patients with plastic bronchitis were younger (8.9 vs 11.1 years, P = .02), but had few other differences in baseline characteristics. A fewer Fontan patients with plastic bronchitis were listed in the more recent era (46 [15.4%] in 2010-2014 vs 23 [6.6%] in 2015-2018, P < .01). Overall, there was no difference in waitlist (P = .30) or post-transplant (P = .66) survival for Fontan patients with and without plastic bronchitis. The results were similar after excluding patients with PLE. Contrary to prior reports, this relatively large series showed that plastic bronchitis did not have a negative impact on survival to or after heart transplantation in Fontan patients. Our study also found a 50% reduction in listing in the current era, which may indicate evolution in management of Fontan patients.
塑料性支气管炎是法洛四联症术后的一种罕见并发症，治疗选择有限。心脏移植已成为一种潜在的治疗选择，但结果尚未明确。本研究旨在评估患有塑料性支气管炎的患者在等待心脏移植和移植后的当代结果。在 PHTS 数据库中（2010 年至 2018 年）确定了所有法洛四联症患者。比较了有和没有塑料性支气管炎的法洛四联症患者在等待心脏移植和移植后的结果。采用竞争结果和 Kaplan-Meier 分析评估了塑料性支气管炎对等待心脏移植和移植后生存的影响。二次分析将比较队列中排除了患有肺静脉异位引流的患者。在 645 名接受心脏移植的法洛四联症患者中，有 69 名（11%）患有塑料性支气管炎。在登记时，患有塑料性支气管炎的患者年龄较小（8.9 岁 vs 11.1 岁，P=0.02），但在基线特征方面几乎没有其他差异。在较新的时期，患有塑料性支气管炎的法洛四联症患者较少被列入名单（2010-2014 年有 46 名[15.4%]，2015-2018 年有 23 名[6.6%]，P<.01）。总的来说，患有和不患有塑料性支气管炎的法洛四联症患者在等待心脏移植和移植后，其等待名单（P=0.30）或移植后（P=0.66）的生存率没有差异。在排除了患有肺静脉异位引流的患者后，结果相似。与之前的报告相反，本研究结果显示，在法洛四联症患者中，塑料性支气管炎并未对心脏移植后的生存产生负面影响。我们的研究还发现，当前时期的登记人数减少了 50%，这可能表明法洛四联症患者的管理方式发生了演变。
