Bakthavatsalam Arvind, Hwang Billanna, Mulligan Michael S
Department of Surgery, Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York.
Department of Surgery, University of Washington, Seattle, Washington.
JHLT Open. 2025 Jan 21;8:100218. doi: 10.1016/j.jhlto.2025.100218. eCollection 2025 May.
Lung transplantation (LTx) is a key treatment for end-stage pulmonary disease, yet survival lags other organ transplants. Prior major cardiothoracic (CT) may negatively affect short- and long-term outcomes but is not a contraindication to LTx. This study investigates the effect of prior major CT surgery on LTx short- and long-term outcomes.
We retrospectively analyzed LTx patients between January 1, 2010 and October 1, 2018. Patients were stratified into Prior Major CT and No Major CT groups with charts evaluated for hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator duration, and survival between the 2 groups.
Of 426 patients identified, the No Major CT group had 378 patients and the Prior Major CT group had 48 patients. Median LOS, ICU LOS, and ventilator duration were 15 ± 2.2 days, 6 ± 2.3 days, and 2 ± 1.8 days in the Prior Major CT group compared to 16 ± 0.8 days, 5 ± 0.6 days, and 1 ± 0.4 days in the No Major CT group, respectively ( = 0.76, = 0.23, = 0.03). The Kaplan-Meier analysis showed 1-, 3-, and 5-year survival of 72.9%, 56.2%, and 50% vs 89.9%, 81%, and 73.3% in the Prior Major CT group vs the No Major CT group, respectively ( < 0.01).
Major CT procedures have negative impacts on postoperative outcomes with a longer ventilator duration and worse long-term survival. Prior Major CT surgery should not necessarily be a contraindication for LTx, but a risk factor to be considered by clinicians when considering LTx candidacy.
肺移植（LTx）是终末期肺部疾病的关键治疗方法，但与其他器官移植相比，其生存率较低。既往进行过大的心胸（CT）手术可能会对短期和长期预后产生负面影响，但并非肺移植的禁忌症。本研究调查既往进行过大的CT手术对肺移植短期和长期预后的影响。
我们回顾性分析了2010年1月1日至2018年10月1日期间的肺移植患者。将患者分为既往进行过大的CT手术组和未进行过大的CT手术组，并评估两组患者的住院时间（LOS）、重症监护病房（ICU）住院时间、呼吸机使用时间和生存率。
在426例确诊患者中，未进行过大的CT手术组有378例患者，既往进行过大的CT手术组有48例患者。既往进行过大的CT手术组的中位住院时间、ICU住院时间和呼吸机使用时间分别为15±2.2天、6±2.3天和2±1.8天，而未进行过大的CT手术组分别为16±0.8天、5±0.6天和1±0.4天（=0.76，=0.23，=0.03）。Kaplan-Meier分析显示，既往进行过大的CT手术组与未进行过大的CT手术组的1年、3年和5年生存率分别为72.9%、56.2%和50%，以及89.9%、81%和73.3%（<0.01）。
大的CT手术对术后预后有负面影响，呼吸机使用时间更长，长期生存率更差。既往进行过大的CT手术不一定是肺移植的禁忌症，但临床医生在考虑肺移植候选资格时应将其作为一个风险因素加以考虑。
