Fessler Julien, Glorion Matthieu, Finet Michaël, Soniak Claire, de Verdiere Sylvie Colin, Sage Edouard, Roux Antoine, Zuber Benjamin, Fischler Marc, Guen Morgan Le, Vallée Alexandre
Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France.
J Cardiothorac Vasc Anesth. 2023 Jun;37(6):964-971. doi: 10.1053/j.jvca.2023.02.029. Epub 2023 Feb 23.
Life expectancy for lung-transplant patients, especially those with cystic fibrosis (CF), is leading increasingly to more retransplantations.
Retrospective monocentric cohort study.
Foch University Hospital, Suresnes, France.
CF patients having had a primary double-lung transplantation (pLgTx) or a retransplantation (reLgTx) from 2012 to 2021.
None.
The authors compared the main intraoperative and early postoperative features between pLgTx (n = 258) and reLgTx (n = 24). Demographic characteristics were similar. No patients with retransplantations had a preoperative bridge with extracorporeal membrane oxygenation (ECMO); however, 23 patients had it in the pLgTx group (p = 0.24). Patients with retransplants had longer second graft ischemic time (p = 0.02), larger intraoperative bleeding volume (p = 0.001) and blood transfusion (p = 0.009 for packed red blood cells), increased blood lactate concentrations (p = 0.002), and higher norepinephrine dose at end-surgery (p = 0.001). Extracorporeal membrane oxygenation was used during surgery in 94 patients in the pLgTx group and 12 patients in the reLgTx group (p = 0.39). Extracorporeal membrane oxygenation could not be weaned after surgery in 55 patients in the pLgTx group and 4 in the reLgTx group (p = 0.54). Despite worse preoperative renal function in the reLgTx group (p < 0.001), there was no difference concerning renal replacement therapy in the intensive care unit between groups (p = 0.08). There were no differences between groups concerning the main complications, including primary graft dysfunction. Although the difference was not statistically different (p = 0.17), mortality was 3 times higher in the reLgTx group.
Intraoperative period of retransplantation was more convoluted but had a similar ECMO profile to primary transplantation. In addition, the early postoperative period was similar.
肺移植患者，尤其是囊性纤维化（CF）患者的预期寿命延长，导致再次移植的情况越来越多。
回顾性单中心队列研究。
法国叙雷讷的福煦大学医院。
2012年至2021年期间接受初次双肺移植（pLgTx）或再次移植（reLgTx）的CF患者。
无。
作者比较了pLgTx组（n = 258）和reLgTx组（n = 24）主要的术中及术后早期特征。人口统计学特征相似。再次移植的患者术前均未使用体外膜肺氧合（ECMO）作为过渡；然而，pLgTx组有23例患者使用了ECMO（p = 0.24）。再次移植患者的第二次移植物缺血时间更长（p = 0.02），术中出血量更大（p = 0.001），输血情况（浓缩红细胞p = 0.009）更多，血乳酸浓度升高（p = 0.002），手术结束时去甲肾上腺素剂量更高（p = 0.001）。pLgTx组94例患者和reLgTx组12例患者在手术期间使用了体外膜肺氧合（p = 0.39）。pLgTx组55例患者和reLgTx组4例患者术后无法撤掉体外膜肺氧合（p = 0.54）。尽管reLgTx组术前肾功能较差（p < 0.001），但两组在重症监护病房进行肾脏替代治疗方面无差异（p = 0.08）。两组在包括原发性移植物功能障碍在内的主要并发症方面无差异。尽管差异无统计学意义（p = 0.17），但reLgTx组的死亡率高出3倍。
再次移植的术期更为复杂，但体外膜肺氧合情况与初次移植相似。此外，术后早期情况也相似。
