Ahmad Danial, Ferrell Brandon E, Saxena Abhiraj, Jimenez Diana C, O'Malley Thomas J, Dispagna Marco A, Grenda Tyler, Tchantchaleishvili Vakhtang
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY, USA.
J Thorac Dis. 2023 Jul 31;15(7):3627-3635. doi: 10.21037/jtd-23-63. Epub 2023 Jul 17.
Lung volume reduction (LVR) and lung transplantation (LTx) have been used in different populations of chronic obstructive pulmonary disease (COPD) patients. To date, comparative study of LVR and LTx has not been performed. We sought to address this gap by pooling the existing evidence in the literature.
An electronic search was performed to identify all prospective studies on LVR and LTx published since 2000. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis.
The analysis included 65 prospective studies comprising 3,671 patients [LTx: 15 studies (n=1,445), LVR: 50 studies (n=2,226)]. Mean age was 60 [95% confidence interval (CI): 58-62] years and comparable between the two groups. Females were 51% (95% CI: 30-71%) in the LTx group 28% (95% CI: 21-36%) in LVR group (P=0.05). Baseline 6-minute walk test (6MWT) and pulmonary function tests were comparable except for the forced expiratory volume in 1 second (FEV1), which was lower in the LTx group [21.8% (95% CI: 16.8-26.7%) 27.3% (95% CI: 25.5-29.2%), P=0.04]. Postoperatively, both groups experienced improved FEV1, however post-LTx FEV1 was significantly higher than post-LVR FEV1 [54.9% (95% CI: 41.4-68.4%) 32.5% (95% CI: 30.1-34.8%), P<0.01]. 6MWT was also improved after both procedures [LTx: 212.9 (95% CI: 119.0-306.9) to 454.4 m (95% CI: 334.7-574.2), P<0.01; LVR: 286 (95% CI: 270.2-301.9) to 409.1 m (95% CI: 392.1-426.0), P<0.01], however, with no significant difference between the groups. Pooled survival over time showed no significant difference between the groups.
LTx results in better FEV1 but otherwise has comparable outcomes to LVR.
肺减容术（LVR）和肺移植（LTx）已应用于不同人群的慢性阻塞性肺疾病（COPD）患者。迄今为止，尚未对LVR和LTx进行比较研究。我们试图通过汇总文献中的现有证据来填补这一空白。
进行电子检索，以识别自2000年以来发表的所有关于LVR和LTx的前瞻性研究。提取基线特征、围手术期变量和临床结局并进行汇总以进行荟萃分析。
分析包括65项前瞻性研究，共3671例患者[LTx：15项研究（n = 1445），LVR：50项研究（n = 2226）]。平均年龄为60岁[95%置信区间（CI）：58 - 62]，两组之间具有可比性。LTx组女性占51%（95% CI：30 - 71%），LVR组女性占28%（95% CI：21 - 36%）（P = 0.05）。除1秒用力呼气量（FEV1）外，基线6分钟步行试验（6MWT）和肺功能测试具有可比性，LTx组的FEV1较低[21.8%（95% CI：16.8 - 26.7%）对27.3%（95% CI：25.5 - 29.2%），P = 0.04]。术后，两组的FEV1均有所改善，但LTx术后的FEV1显著高于LVR术后的FEV1[54.9%（95% CI：41.4 - 68.4%）对32.5%（95% CI：30.1 - 34.8%），P < 0.01]。两种手术术后6MWT也均有改善[LTx：从212.9米（95% CI：119.0 - 306.9）提高到454.4米（95% CI：334.7 - 574.2），P < 0.01；LVR：从286米（95% CI：270.2 - 301.9）提高到409.1米（95% CI：392.1 - 426.0），P < 0.01]，但两组之间无显著差异。随时间推移的汇总生存率显示两组之间无显著差异。
LTx可使FEV1改善更好，但在其他方面与LVR的结局相当。
