Division of Cardiovascular Surgery, Department of Surgery, Temple University Hospital, Philadelphia, PA.
Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA.
Transplantation. 2022 Nov 1;106(11):2241-2246. doi: 10.1097/TP.0000000000004191. Epub 2022 Jun 6.
Although double lung transplant is recommended in patients with severe secondary pulmonary hypertension (SPH), our institutional experiences suggest a role for single lung transplant in these patients. Here, we review our experience prioritizing single lung transplant in patients with SPH to minimize their surgical burden.
We conducted a retrospective review of our lung transplant database to identify patients with SPH who underwent single lung transplant. Patients were stratified as either mild SPH (mean pulmonary artery pressure 25-40 mm Hg) or severe SPH (mean pulmonary artery pressure >40 mm Hg). Singe lung recipients without PH transplanted over the same time were also examined.
Between January 2017 and December 2019, 318 patients underwent single lung transplantation; 217 had mild SPH (68%), and 59 had severe SPH (18.5%). Forty-two patients without PH underwent single lung transplant. When the groups were compared, significantly higher pulmonary vascular resistance was noted in the severe SPH group, and obesity was noted in both the mild and severe SPH groups. Although the severe SPH group required more intraoperative cardiopulmonary support (37.3% versus 10.3% versus 4.7%, P < 0.05), there were no significant differences in most major postoperative parameters, including the duration of postoperative mechanical ventilation or the incidence of severe primary graft dysfunction. Survival 1 y posttransplant was not significantly different among the groups (93.2% versus 89.4% versus 92.9%, P = 0.58).
Our experience supports the option of single lung transplantation with appropriate intraoperative mechanical circulatory support in patients with SPH. This strategy is worth pursuing, especially with ongoing donor lung shortages.
尽管双肺移植是治疗严重继发性肺动脉高压（SPH）患者的推荐方法，但我们的机构经验表明，在这些患者中单肺移植也具有一定作用。在此，我们回顾了我们在 SPH 患者中单肺移植的经验，以尽量减轻他们的手术负担。
我们对我们的肺移植数据库进行了回顾性分析，以确定接受单肺移植的 SPH 患者。患者分为轻度 SPH（平均肺动脉压 25-40mmHg）或重度 SPH（平均肺动脉压>40mmHg）。同时还检查了同期无 PH 的单肺受者。
2017 年 1 月至 2019 年 12 月期间，共有 318 名患者接受了单肺移植；217 名患者患有轻度 SPH（68%），59 名患者患有重度 SPH（18.5%）。42 名无 PH 的患者接受了单肺移植。在这些组之间进行比较时，重度 SPH 组的肺血管阻力明显更高，而轻度和重度 SPH 组都存在肥胖。尽管重度 SPH 组需要更多的术中心肺支持（37.3%比 10.3%比 4.7%，P<0.05），但大多数主要术后参数（包括术后机械通气的持续时间或严重原发性移植物功能障碍的发生率）没有显著差异。移植后 1 年的生存率在各组之间没有显著差异（93.2%比 89.4%比 92.9%，P=0.58）。
我们的经验支持在 SPH 患者中单肺移植并适当应用术中机械循环支持的选择。这种策略是值得追求的，特别是在持续存在供肺短缺的情况下。
