Tanaka Satona, Takahashi Mamoru, Kayawake Hidenao, Yutaka Yojiro, Ohsumi Akihiro, Nakajima Daisuke, Ikezoe Kohei, Tanizawa Kiminobu, Handa Tomohiro, Date Hiroshi
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
J Thorac Cardiovasc Surg. 2025 Jul;170(1):86-95.e2. doi: 10.1016/j.jtcvs.2024.10.004. Epub 2024 Oct 10.
To explore the characteristics and prognostic impact of chronic lung allograft dysfunction (CLAD) after deceased-donor lung transplantation and living-donor lobar lung transplantation, wherein the lower lobes from 2 donors are usually transplanted into one recipient.
The clinical data of 123 deceased-donor and 67 living-donor lung transplantations performed in adult patients at our institution between June 2008 and September 2019 were retrospectively reviewed. The cumulative incidence of CLAD was evaluated on a per-recipient and per-donor graft basis using the Kaplan-Meier method.
A smaller number of human leukocyte antigen mismatches, shorter ischemic time, and lower incidence of grade 3 primary graft dysfunction were observed in living-donor transplantation than in deceased-donor transplantation (P < .001). Restrictive allograft syndrome-type CLAD occurred in 9 (20.9%) of 43 patients with CLAD after deceased-donor transplantation and 9 (45.0%) of 20 patients with CLAD after living-donor transplantation. CLAD occurred unilaterally in 15 patients (75.0%) after bilateral living-donor transplantation. Despite the greater incidence of restrictive allograft syndrome-type CLAD after living-donor transplantation, the overall survival rates after the transplantation and survival rates after the onset of CLAD were comparable between the patients receiving deceased-donor transplants and living-donor transplants. The cumulative incidence of CLAD per recipient was similar between recipients of deceased-donor and the living-donor transplants (P = .32). In the per-donor graft analysis, the cumulative incidence of CLAD was significantly lower in the living-donor grafts than in the deceased-donor grafts (P = .003).
The manifestation of CLAD after living-donor lobar lung transplantation is unique and differs from that after deceased-donor lung transplantation.
探讨脑死亡供者肺移植及活体供者肺叶移植后慢性肺移植功能障碍（CLAD）的特点及预后影响，其中通常将2名供者的下叶移植给1名受者。
回顾性分析2008年6月至2019年9月在本机构对成年患者进行的123例脑死亡供者肺移植和67例活体供者肺移植的临床资料。采用Kaplan-Meier法按受者和供者移植物评估CLAD的累积发生率。
与脑死亡供者移植相比，活体供者移植中观察到人类白细胞抗原错配数量较少、缺血时间较短以及3级原发性移植功能障碍发生率较低（P <.001）。在脑死亡供者移植后发生CLAD的43例患者中，9例（20.9%）发生了限制性移植物综合征型CLAD；在活体供者移植后发生CLAD的20例患者中，9例（45.0%）发生了该类型CLAD。双侧活体供者移植后，15例患者（75.0%）单侧发生CLAD。尽管活体供者移植后限制性移植物综合征型CLAD的发生率较高，但接受脑死亡供者移植和活体供者移植的患者移植后的总体生存率以及CLAD发病后的生存率相当。脑死亡供者和活体供者移植受者中，每位受者CLAD的累积发生率相似（P =.32）。在按供者移植物分析中，活体供者移植物中CLAD的累积发生率显著低于脑死亡供者移植物（P =.003）。
活体供者肺叶移植后CLAD的表现独特，与脑死亡供者肺移植后的表现不同。
