Ander Erik H, Kashem Abul, Zhao Huaqing, Montgomery Kelly, Sunagawa Gengo, Yanagida Roh, Shigemura Norihisa, Toyoda Yoshiya
Division of Cardiothoracic Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Division of Cardiothoracic Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
J Surg Res. 2022 Mar;271:125-136. doi: 10.1016/j.jss.2021.10.027. Epub 2021 Dec 11.
Idiopathic pulmonary fibrosis (IPF) accounts for a marked proportion of diagnoses on the US lung transplant (LTx) list. The effects of single (SLT) versus double LTx (DLT) and lung donor age on survival in IPF remain unclear and were investigated in this study.
We retrospectively assessed survival of LTx recipients with IPF at a single institution from February 2012-March 2020. Survival was analyzed and compared between LTx types (SLT and DLT), donor ages, and the combined groups (LTx type & donor age) using Kaplan-Meier survival analysis and compared by log-rank test. P-values less than 0.05 were considered significant.
Of 744 LTx patients at our institution, 307 (41.3%) were diagnosed with IPF, of which 208 (67.8%) were SLT, and 97 (31.6%) were DLT (2 excluded patients underwent heart-lung transplantation). There was no significant difference in survival due to LTx type (P = 0.41) or for patients with donor age <50 or ≥50 y (P = 0.46). Once stratified by both LTx type and donor age, analysis showed no significant difference in survival between the four groups (P = 0.69).
With ethical consideration for organ allocation, as the average age of the US population increases, donor lungs aged ≥50 are an increasingly useful resource in LTx. Our findings suggest donor age and LTx type do not significantly affect survival. Therefore, SLT, and donor lungs aged ≥50 ought to be more readily considered as non-inferior options for LTx in patients with IPF.
特发性肺纤维化（IPF）在美国肺移植（LTx）名单诊断中占显著比例。单肺移植（SLT）与双肺移植（DLT）以及肺供体年龄对IPF患者生存的影响仍不明确，本研究对此进行了调查。
我们回顾性评估了2012年2月至2020年3月在单一机构接受LTx的IPF患者的生存情况。使用Kaplan-Meier生存分析对LTx类型（SLT和DLT）、供体年龄以及联合组（LTx类型和供体年龄）之间的生存情况进行分析和比较，并通过对数秩检验进行比较。P值小于0.05被认为具有统计学意义。
在我们机构的744例LTx患者中，307例（41.3%）被诊断为IPF，其中208例（67.8%）为SLT，97例（31.6%）为DLT（2例排除患者接受了心肺移植）。LTx类型对生存无显著差异（P = 0.41），供体年龄<50岁或≥50岁的患者生存情况也无显著差异（P = 0.46）。一旦按LTx类型和供体年龄进行分层分析，四组之间的生存情况无显著差异（P = 0.69）。
出于器官分配的伦理考虑，随着美国人口平均年龄的增加，年龄≥50岁的供体肺在LTx中是越来越有用的资源。我们的研究结果表明，供体年龄和LTx类型对生存无显著影响。因此，SLT以及年龄≥50岁的供体肺应更被视为IPF患者LTx的非劣选方案。
