Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, 4-1 Seiryomachi, Sendai, Miyagi, 980-8575, Japan.
Division of Organ Transplantation, Tohoku University Hospital, 1-1 Seiryomachi, Sendai, Miyagi, 980-8574, Japan.
BMC Pulm Med. 2021 Nov 29;21(1):390. doi: 10.1186/s12890-021-01760-8.
As lung transplantation (LTX) is a valuable treatment procedure for end-stage pulmonary disease, delayed referral to a transplant center should be avoided. We aimed to conduct a single-center analysis of the survival time after listing for LTX and waitlist mortality in each disease category in a Japanese population.
We included patients listed for LTX at Tohoku University Hospital from January 2007 to December 2020 who were followed up until March 2021. Pulmonary disease was categorized into the Obstructive, Vascular, Suppurative, Fibrosis, and Allogeneic groups. Risk factors for waitlist mortality were assessed using a Cox proportional hazards model. The Kaplan-Meier method was used to model time to death.
We included 269 LTX candidates. Of those, 100, 72, and 97 patients were transplanted, waiting, and dead, respectively. The median time to LTX and time to death were 796 days (interquartile range [IQR] 579-1056) and 323 days (IQR 129-528), respectively. The Fibrosis group showed the highest mortality (50.9%; p < .001), followed by the Allogeneic (35.0%), Suppurative (33.3%), Vascular (32.1%), and Obstructive (13.1%) groups. The Fibrosis group showed a remarkable risk for waitlist mortality (hazard ratio 3.32, 95% CI 2.11-4.85).
In Japan, the waiting time is extremely long and candidates with Fibrosis have high mortality. There is a need to document outcomes based on the underlying disease for listed LTX candidates to help determine the optimal timing for listing patients based on the estimated local waiting time.
肺移植（LTX）是治疗终末期肺部疾病的一种有价值的治疗方法，应避免将患者延迟转诊至移植中心。我们旨在对日本人群中每个疾病类别的 LTX 名单后生存时间和候补者死亡率进行单中心分析。
我们纳入了 2007 年 1 月至 2020 年 12 月在东北大学医院接受 LTX 名单的患者，并随访至 2021 年 3 月。肺部疾病分为阻塞性、血管性、化脓性、纤维化和同种异体组。使用 Cox 比例风险模型评估候补者死亡的危险因素。采用 Kaplan-Meier 法构建死亡时间模型。
我们纳入了 269 名 LTX 候选者。其中，100、72 和 97 名患者分别接受了移植、等待和死亡。LTX 时间和死亡时间的中位数分别为 796 天（IQR 579-1056）和 323 天（IQR 129-528）。纤维化组死亡率最高（50.9%；p<0.001），其次是同种异体（35.0%）、化脓性（33.3%）、血管性（32.1%）和阻塞性（13.1%）组。纤维化组候补者死亡率风险显著（危险比 3.32，95%CI 2.11-4.85）。
在日本，等待时间极长，纤维化患者死亡率高。需要根据列出的 LTX 候选者的基础疾病记录结果，以帮助根据当地估计的等待时间确定列出患者的最佳时机。
