Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
Chest. 2021 Nov;160(5):1743-1750. doi: 10.1016/j.chest.2021.06.036. Epub 2021 Jun 26.
Combined pulmonary fibrosis and emphysema (CPFE) is recognized as a characteristic syndrome of smoking-related interstitial lung disease that has a worse prognosis than idiopathic pulmonary fibrosis (IPF). However, outcomes after lung transplantation for CPFE have not been reported. The aim of this study is to describe the clinical features and outcomes of CPFE after lung transplantation.
What are the clinical features and outcomes of CPFE after lung transplantation?
This is a single-center retrospective cohort study of patients with CPFE and IPF who underwent lung transplantation at our center between January 2011 and December 2016. We defined CPFE as ≥10% emphysema in the upper lung fields combined with fibrosis on high-resolution CT scan. We characterized the clinical features of patients with CPFE and compared their outcomes after lung transplantation with those with IPF.
Twenty-seven of 172 (16%) patients with IPF met criteria for CPFE. Severe pulmonary hypertension was present in 16 of 27 (59%) patients with CPFE. On logistic regression analysis, CPFE was significantly associated with primary graft dysfunction (PGD) grade 3 (OR, 3.14; 95% CI, 1.18-8.37; P = .02). On competing risk regression analysis, CPFE was associated with acute cellular rejection (ACR) grade ≥ A2, and chronic lung allograft dysfunction (CLAD) (hazard ratio [HR], 1.89; 95% CI, 1.10-3.25; P = .02; HR, 1.96; 95% CI, 1.02-3.77; P = .04, respectively). Five-year survival was 79.0% for the CPFE group and 75.4% for the IPF group (log-rank P = .684).
After transplantation, patients with CPFE were more likely to develop PGD, ACR, and CLAD compared with those with IPF. However, survival was not significantly different between the two groups.
合并性肺纤维化和肺气肿（CPFE）被认为是一种与吸烟相关的间质性肺疾病的特征性综合征，其预后比特发性肺纤维化（IPF）更差。然而，CPFE 患者肺移植后的结果尚未见报道。本研究旨在描述 CPFE 患者肺移植后的临床特征和结局。
CPFE 患者肺移植后的临床特征和结局是什么？
这是一项单中心回顾性队列研究，纳入了 2011 年 1 月至 2016 年 12 月期间在我院接受肺移植的 CPFE 和 IPF 患者。我们将 CPFE 定义为高分辨率 CT 扫描上≥10%的上肺野肺气肿合并纤维化。我们描述了 CPFE 患者的临床特征，并比较了他们肺移植后的结局与 IPF 患者的结局。
172 例 IPF 患者中，有 27 例（16%）符合 CPFE 的标准。27 例 CPFE 患者中有 16 例（59%）存在严重肺动脉高压。在 logistic 回归分析中，CPFE 与 3 级原发性移植物功能障碍（PGD）显著相关（OR，3.14；95%CI，1.18-8.37；P=0.02）。在竞争风险回归分析中，CPFE 与急性细胞排斥（ACR）≥A2 级和慢性肺移植物功能障碍（CLAD）相关（风险比[HR]，1.89；95%CI，1.10-3.25；P=0.02；HR，1.96；95%CI，1.02-3.77；P=0.04）。CPFE 组 5 年生存率为 79.0%，IPF 组为 75.4%（对数秩 P=0.684）。
与 IPF 患者相比，CPFE 患者移植后更易发生 PGD、ACR 和 CLAD，但两组患者的生存率无显著差异。
