Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland.
Division of Pulmonology, Zurich University Hospital, University of Zurich, Zurich, Switzerland.
Ann Thorac Cardiovasc Surg. 2021 Aug 20;27(4):244-250. doi: 10.5761/atcs.oa.20-00237. Epub 2021 Jan 20.
Cadaveric lobar lung transplantation (L-LTx) is developed to overcome donor-recipient size mismatch. Controversial short- and long-term outcomes following L-LTx have been reported compared to full-sized lung transplantation (F-LTx). This study reports long-term outcomes after L-LTx.
We reviewed patients undergoing lung transplantation (LTx) between 2000 and 2016. The decision to perform L-LTx was made based mainly on donor-recipient height discrepancy and visual assessment of donor lungs. Predicted donor-recipient total lung capacity (TLC) ratio was calculated more recently. Primary outcome was overall survival.
In all, 370 bilateral LTx were performed during the study period, among those 250 (67%) underwent F-LTx and 120 (32%) underwent L-LTx, respectively. One- and 5-year survival rates were 85% vs. 90% and 53% vs. 63% for L-LTx and F-LTx, respectively (p = 0.16). Chronic lung allograft dysfunction (CLAD)-free survival at 5 years was 48% in L-LTx vs. 51% in F-LTx recipients (p = 0.89), respectively. Age, intraoperative extracorporeal membrane oxygenation (ECMO) use, intensive care unit (ICU) stay, and postoperative renal replacement therapy (RRT) were significant prognostic factors for survival using multivariate analysis.
Overall survival and CLAD-free survival following L-LTx were comparable to F-LTx. Given the ongoing donor organ shortage, cadaveric L-LTx remains as an important resource in LTx.
为了克服供体-受体大小不匹配的问题，开展了尸体肺叶移植（L-LTx）。与全肺移植（F-LTx）相比，L-LTx 后的短期和长期结果存在争议。本研究报告了 L-LTx 后的长期结果。
我们回顾了 2000 年至 2016 年间接受肺移植（LTx）的患者。进行 L-LTx 的决定主要基于供体-受体身高差异和对供体肺的视觉评估。最近计算了预测的供体-受体总肺容量（TLC）比值。主要结局是总生存率。
在研究期间共进行了 370 例双侧 LTx，其中 250 例（67%）接受了 F-LTx，120 例（32%）接受了 L-LTx。L-LTx 和 F-LTx 的 1 年和 5 年生存率分别为 85%和 90%，53%和 63%（p=0.16）。L-LTx 组 5 年无慢性肺移植物功能障碍（CLAD）生存率为 48%，F-LTx 组为 51%（p=0.89）。多因素分析显示，年龄、术中体外膜肺氧合（ECMO）使用、重症监护病房（ICU）停留时间和术后肾脏替代治疗（RRT）是生存率的显著预后因素。
L-LTx 的总生存率和无 CLAD 生存率与 F-LTx 相当。鉴于供体器官短缺，尸体 L-LTx 仍然是 LTx 的重要资源。
