美国的肺肾联合移植。
Simultaneous Lung-Kidney Transplantation in the United States.
机构信息
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California.
出版信息
Ann Thorac Surg. 2023 Nov;116(5):1063-1070. doi: 10.1016/j.athoracsur.2023.06.003. Epub 2023 Jun 24.
BACKGROUND
Simultaneous lung-kidney transplantation is rarely performed. Contemporary national practice trends and outcomes are unclear.
METHODS
From the United Network for Organ Sharing database, we identified 108 lung-kidney transplant recipients (2005-2022). They were compared with isolated lung recipients with pretransplantation dialysis or estimated glomerular filtration rate (eGFR) ≤30 mL/min per 1.73 m (n = 372) and isolated non-dialysis-dependent lung recipients with 30 < eGFR < 50 mL/min per 1.73 m (n = 1416), respectively. Lung-kidney recipients were also compared with recipients of the contralateral kidney from the same donors (n = 90).
RESULTS
Lung-kidney transplantation was performed by 36 centers, with increasing annual volume (1 in 2005, 16 in 2022; P < .01). Forty percent (44/108) of lung-kidney recipients received pretransplantation dialysis, and of those without pretransplantation dialysis, median eGFR was 30.7 mL/min per 1.73 m. Lung-kidney recipients had improved survival compared with isolated lung recipients with eGFR ≤30 mL/min per 1.73 m or pretransplantation dialysis (adjusted hazard ratio, 0.59; 95% CI, 0.38-0.92). However, no survival benefit was observed when lung-kidney recipients were compared with isolated lung recipients with 30 < eGFR < 50 mL/min per 1.73 m and no pretransplantation dialysis (adjusted hazard ratio, 0.88; 95% CI, 0.55-1.41). Compared with isolated kidney recipients using the contralateral kidney from the same donors, lung-kidney recipients had a higher risk of kidney allograft loss (adjusted hazard ratio, 3.27; 95% CI, 1.22-8.78), a difference largely accounted for by patient death with a functioning kidney allograft.
CONCLUSIONS
Recipients of lung-kidney transplants had improved survival compared with isolated lung recipients with eGFR ≤30 mL/min per 1.73 m or pretransplantation dialysis. However, lung-kidney recipients had a higher rate of kidney allograft loss than recipients of the contralateral kidney allograft from the same donors.
背景
同期进行肺肾移植的情况较为少见。目前尚不清楚同期肺肾移植的全国性实践趋势和结果。
方法
我们从美国器官共享网络数据库中确定了 108 例肺肾移植受者（2005 年至 2022 年）。将他们与接受移植前透析或估计肾小球滤过率（eGFR）≤30ml/min/1.73m2 的单纯肺移植受者（n=372）以及 eGFR 为 30<eGFR<50ml/min/1.73m2 但未接受透析的单纯非透析依赖性肺移植受者（n=1416）进行了比较。此外，我们还将肺肾移植受者与来自同一供体的对侧肾脏移植受者（n=90）进行了比较。
结果
该研究在 36 个中心进行了肺肾移植，且年度移植量呈递增趋势（2005 年为 1 例，2022 年为 16 例；P<0.01）。40%（44/108）的肺肾移植受者在移植前接受了透析治疗，而在未接受透析治疗的患者中，中位 eGFR 为 30.7ml/min/1.73m2。与接受移植前透析或 eGFR≤30ml/min/1.73m2 的单纯肺移植受者相比，肺肾移植受者的生存率有所提高（调整后的危险比，0.59；95%CI，0.38-0.92）。然而，与未接受透析治疗且 eGFR 为 30<eGFR<50ml/min/1.73m2 的单纯肺移植受者相比，肺肾移植受者的生存率并无显著改善（调整后的危险比，0.88；95%CI，0.55-1.41）。与使用同一供体的对侧肾脏的单纯肾脏移植受者相比，肺肾移植受者的肾脏移植物丢失风险更高（调整后的危险比，3.27；95%CI，1.22-8.78），这主要是由于移植后患者死亡但肾脏移植物仍在发挥功能所致。
结论
与接受移植前透析或 eGFR≤30ml/min/1.73m2 的单纯肺移植受者相比，肺肾移植受者的生存率有所提高。然而，与使用同一供体的对侧肾脏的单纯肾脏移植受者相比，肺肾移植受者的肾脏移植物丢失率更高。
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