Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Clin Transplant. 2024 Dec;38(12):e70041. doi: 10.1111/ctr.70041.
Delayed chest closure (DCC) during lung transplantation (LTx) is a controversial surgical approach that lacks research in systemic sclerosis (SSc) patients. We investigated outcomes, clinical risk factors, and CT-based lung size-matching parameters associated with DCC in SSc recipients.
This retrospective study included 92 SSc recipients (age 51 years ± 10, 56/92 (61.0%) females) who underwent bilateral LTx between 2007 and 2020. Of the recipients, 34.8% (32/92) underwent DCC. Recipient lung and chest cavity volumes were automatically computed from CT imaging using deep learning algorithms. Survival between groups was compared using Kaplan-Meier analysis. Multivariate logistic regression was used to identify risk factors and predict DCC occurrence using preoperative variables.
Recipients who underwent DCC had longer total vent duration (p = 0.001), more use of postoperative mechanical support (p = 0.001), longer ICU length of stay (p = 0.008), and lower incidence of pneumonia post-operation (p = 0.031). No significant difference in survival was observed between DCC and PCC recipients at 30 days (p = 0.713), 90 days (p = 0.267), 1 year (p = 0.941), and 5 years (p = 0.651). Clinical risk factors for DCC included BMI > 30 kg/m (p = 0.009), tracheostomy (p = 0.002), atrial fibrillation (p = 0.012), decreased preoperative FEV1/FVC (p = 0.013), and previous chest operation (p = 0.020). Two CT-based measurements of lung matching were significantly associated with DCC occurrence (p = 0.021 and 0.050). The regression model achieved a mean AUC of 0.82 (0.70, 0.94) in retrospectively predicting DCC occurrence.
SSc recipients undergoing DCC have similar survival rates but experience more complications than PCC recipients. Clinical risk factors and CT-based size matching can be leveraged to predict DCC pre-transplant.
在肺移植（LTx）过程中延迟关胸（DCC）是一种有争议的手术方法，在系统性硬化症（SSc）患者中缺乏研究。我们研究了 DCC 与 SSc 受者的结局、临床危险因素和基于 CT 的肺大小匹配参数之间的关系。
这项回顾性研究纳入了 2007 年至 2020 年间接受双侧 LTx 的 92 例 SSc 受者（年龄 51 岁±10 岁，56/92 [61.0%] 为女性）。其中 34.8%（32/92）的受者接受了 DCC。使用深度学习算法从 CT 图像中自动计算受者的肺和胸腔容积。使用 Kaplan-Meier 分析比较两组之间的生存率。使用术前变量进行多变量逻辑回归，以确定 DCC 发生的危险因素并进行预测。
接受 DCC 的受者总通气时间更长（p=0.001），术后机械通气支持的使用更多（p=0.001），ICU 住院时间更长（p=0.008），术后肺炎发生率更低（p=0.031）。在 30 天（p=0.713）、90 天（p=0.267）、1 年（p=0.941）和 5 年（p=0.651）时，DCC 和 PCC 受者的生存率无显著差异。DCC 的临床危险因素包括 BMI＞30kg/m（p=0.009）、气管切开术（p=0.002）、心房颤动（p=0.012）、术前 FEV1/FVC 降低（p=0.013）和既往胸部手术（p=0.020）。两个基于 CT 的肺匹配测量与 DCC 的发生显著相关（p=0.021 和 0.050）。回归模型在回顾性预测 DCC 发生方面的平均 AUC 为 0.82（0.70，0.94）。
接受 DCC 的 SSc 受者的生存率相似，但并发症发生率高于 PCC 受者。临床危险因素和基于 CT 的大小匹配可用于预测移植前的 DCC。
