Nagata Shunichi, Ohsumi Akihiro, Handa Tomohiro, Yamada Yoshito, Tanaka Satona, Yutaka Yojiro, Nakajima Daisuke, Tanizawa Kiminobu, Hirai Toyohiro, Date Hiroshi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Thoracic Surgery, Nagara Medical Center, Gifu, Japan.
Gen Thorac Cardiovasc Surg. 2023 Jan;71(1):20-26. doi: 10.1007/s11748-022-01861-z. Epub 2022 Aug 7.
Lung transplantation (LT) is an effective treatment for patients with interstitial lung disease (ILD) refractory to medical treatment. Although the cases of cadaveric LT (CLT) have increased, the donor shortage in Japan has remained severe. This study aimed to evaluate the International Society of Heart and Lung Transplantation (ISHLT) listing criteria for LT in patients with ILD by predicting outcomes during the waiting time for CLT.
We retrospectively identified 166 patients with fibrotic ILDs who were evaluated and registered for CLT at Kyoto Universal Hospital from April 1, 2008, to December 31, 2017. We examined the correlation between individual parameters of the ISHLT listing criteria and patient outcomes.
Among 166 patients, 57 (34.3%) underwent CLT, whereas 83 (50.0%) died before CLT. The median survival time from the date of registration was 22.5 months. The 2-year survival rate was 47.8%. On multivariate Cox proportional hazards analysis, relative decline of percent predicted forced vital capacity (%FVC) in 6 months ≥ 10% (hazard ratio [HR]: 1.72; 95% confidence interval [95%CI]: 1.03-2.87, p = 0.04) and 6-min walking distance (6MWD) < 250 m (HR: 2.77; 95%CI: 1.64-4.69, p < 0.001) were independently associated with worse outcome (i.e., death or living-donor lobar LT).
The 2014 ISHLT criteria could appropriately identify patients with ILD who have a potentially poor prognosis. In particular, 6-month decline in %FVC and shorter 6 min walk distance may be useful for selecting patients with higher risks of mortality.
肺移植（LT）是治疗内科治疗无效的间质性肺疾病（ILD）患者的有效方法。尽管尸体肺移植（CLT）病例有所增加，但日本的供体短缺问题仍然严重。本研究旨在通过预测CLT等待期间的结局来评估国际心肺移植协会（ISHLT）针对ILD患者的LT列入标准。
我们回顾性确定了2008年4月1日至2017年12月31日期间在京都大学医院接受评估并登记CLT的166例纤维化ILD患者。我们研究了ISHLT列入标准的各个参数与患者结局之间的相关性。
166例患者中，57例（34.3%）接受了CLT，而83例（50.0%）在CLT前死亡。从登记日期起的中位生存时间为22.5个月。2年生存率为47.8%。多因素Cox比例风险分析显示，6个月内预测用力肺活量百分比（%FVC）相对下降≥10%（风险比[HR]：1.72；95%置信区间[95%CI]：1.03 - 2.87，p = 0.04）和6分钟步行距离（6MWD）<250 m（HR：2.77；95%CI：1.64 - 4.69，p < 0.001）与较差结局（即死亡或活体供肺叶移植）独立相关。
2014年ISHLT标准可以适当识别预后可能较差的ILD患者。特别是，%FVC在6个月内的下降和较短的6分钟步行距离可能有助于选择死亡风险较高的患者。
