Schwarz Stefan, Rahimi Nina, Kifjak Daria, Frommlet Florian, Benazzo Alberto, Jaksch Peter, Klepetko Walter, Hoetzenecker Konrad
Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
J Thorac Cardiovasc Surg. 2022 May;163(5):1719-1731.e2. doi: 10.1016/j.jtcvs.2020.10.150. Epub 2020 Nov 27.
The use of organs from polytrauma donors for lung transplantation is controversial in the literature. For many centers, the radiologic manifestation of lung contusions is a clear reason to reject an organ offer. This results in the loss of potentially viable organs for the donor pool.
We analyzed 1152 donor lungs procured by our transplant center between January 2010 and June 2018. These included 118 lungs with a history of polytrauma involving the chest. Sixteen polytrauma donor lungs were rejected after procurement. A total of 102 lungs were transplanted, divided into 2 groups: the polytrauma contusion group (n = 44), comprising polytrauma donors with radiologic signs of lung contusion at the time of offer, and the polytrauma clear group (n = 58), comprising polytrauma donors without lung contusion. Nontrauma donor lungs transplanted during the study period were assigned to a polytrauma control group (n = 650). Short- and long-term outcomes of the 3 groups were compared.
Basic demographic data and preoperative factors were similar in the 3 groups. Rates of primary graft dysfunction grade 3 at 72 hours did not differ among the 3 groups (0.0% vs 3.4% vs 3.9%; P = .409). The duration of ventilation was similar the 3 groups: 45 hours (interquartile range [IQR], 28-94 hours), 37 hours (IQR, 22-71 hours), and 42 hours (IQR, 22-96 hours), respectively (P = .674). Long-term graft survival was not impaired in the trauma groups compared with controls. One-year survival rates were 84.1% for the polytrauma contusion group, 93.1% for the polytrauma clear group, and 83.1% for the no polytrauma group. Five-year graft survival in the 3 groups was 74.7%, 87.2%, and 70.0%, respectively.
Lung transplantation using organs from polytrauma donors is associated with similar short- and long-term results as transplantation from nontrauma donors. The presence or absence of radiologic signs of lung contusion at the time of offer has no impact on primary graft function and long-term survival.
在文献中，将多发伤供体的器官用于肺移植存在争议。对于许多中心而言，肺挫伤的放射学表现是拒绝接受器官供体的明确理由。这导致供体库中潜在可用器官的损失。
我们分析了2010年1月至2018年6月间由我们的移植中心获取的1152个供体肺。其中包括118个有胸部多发伤病史的肺。16个多发伤供体肺在获取后被拒绝。总共102个肺被移植，分为2组：多发伤挫伤组（n = 44），包括供体时具有肺挫伤放射学征象的多发伤供体；多发伤无挫伤组（n = 58），包括无肺挫伤的多发伤供体。研究期间移植的非创伤供体肺被归入多发伤对照组（n = 650）。比较了3组的短期和长期结果。
3组的基本人口统计学数据和术前因素相似。3组在72小时时3级原发性移植物功能障碍的发生率无差异（0.0%对3.4%对3.9%；P = 0.409）。3组的通气时间相似：分别为45小时（四分位间距[IQR]，28 - 94小时）、37小时（IQR，22 - 71小时）和42小时（IQR，22 - 96小时）（P = 0.674）。与对照组相比，创伤组的长期移植物存活未受损害。多发伤挫伤组的1年生存率为84.1%，多发伤无挫伤组为93.1%，非多发伤组为83.1%。3组的5年移植物生存率分别为74.7%、87.2%和70.0%。
使用多发伤供体的器官进行肺移植与使用非创伤供体进行移植的短期和长期结果相似。供体时肺挫伤放射学征象的有无对原发性移植物功能和长期存活无影响。
