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原发性纤毛运动障碍和卡塔格内综合征的肺移植:一项多中心研究。

Lung Transplantation for Primary Ciliary Dyskinesia and Kartagener Syndrome: A Multicenter Study.

机构信息

Division of Cardiac Surgery, University of Turin, Turin, Italy.

Division of Thoracic Surgery, Columbia University Medical Center, New York, NY, United States.

出版信息

Transpl Int. 2023 Feb 14;36:10819. doi: 10.3389/ti.2023.10819. eCollection 2023.

Abstract

Primary ciliary dyskinesia, with or without situs abnormalities, is a rare lung disease that can lead to an irreversible lung damage that may progress to respiratory failure. Lung transplant can be considered in end-stage disease. This study describes the outcomes of the largest lung transplant population for PCD and for PCD with situs abnormalities, also identified as Kartagener's syndrome. Retrospectively collected data of 36 patients who underwent lung transplantation for PCD from 1995 to 2020 with or without SA as part of the European Society of Thoracic Surgeons Lung Transplantation Working Group on rare diseases. Primary outcomes of interest included survival and freedom from chronic lung allograft dysfunction. Secondary outcomes included primary graft dysfunction within 72 h and the rate of rejection ≥A2 within the first year. Among PCD recipients with and without SA, the mean overall and CLAD-free survival were 5.9 and 5.2 years with no significant differences between groups in terms of time to CLAD (HR: 0.92, 95% CI: 0.27-3.14, = 0.894) or mortality (HR: 0.45, 95% CI: 0.14-1.43, = 0.178). Postoperative rates of PGD were comparable between groups; rejection grades ≥A2 on first biopsy or within the first year was more common in patients with SA. This study provides a valuable insight on international practices of lung transplantation in patients with PCD. Lung transplantation is an acceptable treatment option in this population.

摘要

原发性纤毛运动障碍(PCD)伴或不伴内脏转位(SA)是一种罕见的肺部疾病,可导致不可逆转的肺部损伤,进而发展为呼吸衰竭。在终末期疾病时,可以考虑进行肺移植。本研究描述了最大的 PCD 及 PCD 伴内脏转位(也称为卡塔格内综合征)肺移植患者人群的结局。回顾性收集了 1995 年至 2020 年间欧洲胸外科医师学会肺移植罕见病工作组中 36 例因 PCD 行肺移植且伴或不伴 SA 的患者数据。主要观察终点包括生存率和无慢性肺移植物功能障碍(CLAD)生存率。次要观察终点包括术后 72 小时内原发性移植物功能障碍和术后 1 年内排斥反应≥A2 的发生率。在伴或不伴 SA 的 PCD 受者中,总体生存率和无 CLAD 生存率的平均值分别为 5.9 年和 5.2 年,两组间 CLAD 时间(HR:0.92,95%CI:0.27-3.14, = 0.894)或死亡率(HR:0.45,95%CI:0.14-1.43, = 0.178)均无显著差异。两组术后原发性移植物功能障碍的发生率相似;SA 患者中,术后第一年首次活检或第一年发生的排斥反应≥A2 更常见。本研究为 PCD 患者肺移植的国际实践提供了有价值的见解。肺移植是该人群可接受的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9138/9970992/cd0d72b167d2/ti-36-10819-g001.jpg

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