慢性肺移植功能障碍表型对再次肺移植术后结局的影响：一项回顾性单中心数据分析。
Effect of chronic lung allograft dysfunction phenotypes on the outcome after lung retransplantation: A retrospective single-center data analysis.
作者信息
Auner Sophia, Boehm Panja Maria, Hillebrand Caroline, Schwarz Stefan, Frick Anna Elisabeth, Kovacs Zsofia, Schweiger Thomas, Murakoezy Gabriella, Schaden Eva, Bacher Andreas, Faybik Peter, Tschernko Edda, Taghavi Shahrokh, Jaksch Peter, Aigner Clemens, Hoetzenecker Konrad, Benazzo Alberto
机构信息
Vienna Lung Transplant Program, Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.
出版信息
JTCVS Open. 2024 Nov 19;23:335-348. doi: 10.1016/j.xjon.2024.10.034. eCollection 2025 Feb.
OBJECTIVE
Although retransplantation is the main therapeutic option for end-stage chronic lung allograft dysfunction, several transplant centers consider the "restrictive allograft syndrome" phenotype a contraindication. This selection policy is based on a limited body of literature. The aim of this study was to investigate the association of chronic lung allograft dysfunction phenotypes according to new chronic lung allograft dysfunction definitions with outcomes after retransplantation.
METHODS
This study was a retrospective single-center analysis including patients undergoing lung retransplantation due to chronic lung allograft dysfunction between 2000 and 2021.
RESULTS
Seventy patients were included in the analysis, 73% had bronchiolitis obliterans syndrome, 20% had a mixed phenotype, and 7% had restrictive allograft syndrome. The length of surgery was comparable between the groups. No difference was observed in terms of intraoperative use of packed red blood cells ( = .407), fresh-frozen plasma ( = .173), platelets ( = .300), prothrombin complex concentrates ( = .381), and fibrinogen ( = .808). Patients with non-bronchiolitis obliterans syndrome were more often graded with primary graft dysfunction 3 at arrival to the intensive care unit, and this trend remained at 72 hours after transplantation. After 72 hours, 60% of the cohort was extubated or had primary graft dysfunction grade 0. Early postoperative outcome was comparable between the groups. Survival between the groups did not differ with overall survivals at 1, 5, and 10 years of 72%, 53%, and 51% for bronchiolitis obliterans syndrome and 71%, 56%, and 42% for non-bronchiolitis obliterans syndrome, respectively ( = .841).
CONCLUSIONS
This analysis showed that retransplantation remains a challenging procedure. However, careful patient selection allows excellent outcomes irrespective of chronic lung allograft dysfunction phenotypes.
目的
尽管再次移植是终末期慢性肺移植功能障碍的主要治疗选择，但一些移植中心将“限制性移植综合征”表型视为禁忌证。这种选择政策基于有限的文献资料。本研究的目的是根据新的慢性肺移植功能障碍定义，调查慢性肺移植功能障碍表型与再次移植后结局之间的关联。
方法
本研究是一项回顾性单中心分析，纳入了2000年至2021年间因慢性肺移植功能障碍接受肺再次移植的患者。
结果
70例患者纳入分析，其中73%患有闭塞性细支气管炎综合征，20%具有混合表型，7%患有限制性移植综合征。各组手术时间相当。术中使用浓缩红细胞（P = 0.407）、新鲜冰冻血浆（P = 0.173）、血小板（P = 0.300）、凝血酶原复合物浓缩剂（P = 0.381）和纤维蛋白原（P = 0.808）方面未观察到差异。非闭塞性细支气管炎综合征患者在入住重症监护病房时更常被评为原发性移植功能障碍3级，且这种趋势在移植后72小时仍然存在。72小时后，60%的队列患者拔管或原发性移植功能障碍为0级。各组术后早期结局相当。各组之间的生存率没有差异，闭塞性细支气管炎综合征患者1年、5年和10年的总生存率分别为72%、53%和51%，非闭塞性细支气管炎综合征患者分别为71%、56%和42%（P = 0.841）。
结论
该分析表明再次移植仍然是一项具有挑战性的手术。然而，仔细的患者选择可实现良好结局，而与慢性肺移植功能障碍表型无关。
Zotero 插件