Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated with Nanjing Medical University, Wuxi, China.
Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Interact Cardiovasc Thorac Surg. 2022 Jun 15;35(1). doi: 10.1093/icvts/ivac156.
Lung transplants are still limited by the shortage of suitable donor lungs, especially during the coronavirus disease 2019 pandemic. A heterotopic lung transplant (HLTx), as a flexible surgical procedure, can maximize the potential of donor lungs in an emergency, but its widespread use is hindered by difficulties in anastomosis and paucity of outcome data. We performed a retrospective review of 4 patients, each of whom received an HLTxs over 1 year, including 1 left-to-right single HLTx, 2 right-to-left single HLTxs and 1 lobar HLTx (right upper lobe-to-left). The median recipient age was 58.5 years (46-68); 3 patients were male. The postoperative hospital stay was 33 days (30-42). One recipient lived for 10 years and died of bronchiolitis obliterans syndrome; the others were alive with no major morbidity at 12 to 31 months after the operation with a 1-year survival of 100%. The follow-up chest images showed that transplanted lungs could be inflated well and adapted morphologically to fill the thoracic cavity in the short and long term. This study demonstrates that an HLTx is a feasible alternative to a conventional lung transplant in emergency cases and could be considered in selected patients at advanced medical centres.
肺移植仍然受到合适供体肺短缺的限制，尤其是在 2019 年冠状病毒病大流行期间。作为一种灵活的手术，异位肺移植（HLTx）可以最大限度地发挥供体肺在紧急情况下的潜力，但由于吻合困难和缺乏结果数据，其广泛应用受到阻碍。我们对 4 名患者进行了回顾性研究，每位患者在 1 年内接受了 HLTx，包括 1 例左-右单肺 HLTx、2 例右-左单肺 HLTx 和 1 例肺叶 HLTx（右肺上叶-左肺）。中位受体年龄为 58.5 岁（46-68）；3 名男性。术后住院时间为 33 天（30-42）。1 名受者存活 10 年，死于闭塞性细支气管炎综合征；其余 3 名受者在手术后 12 至 31 个月存活，无重大并发症，1 年生存率为 100%。随访胸部图像显示，移植肺在短期内和长期内都能很好地充气，并在形态上适应胸腔。本研究表明，HLTx 是紧急情况下常规肺移植的一种可行替代方法，在高级医疗中心的选定患者中可以考虑。
