Kolaitis Nicholas A, Barnes Hayley, Levine Deborah J, Castillo Howard, Arcasoy Selim M, Bacchetta Matthew, Benvenuto Luke, Berman-Rosenzweig Erika, Cevasco Marisa, Demarest Caitlin T, Dewachter Celine, Erasmus Michiel E, Glanville Allan R, Granton John, Keshavjee Shaf, Khangoora Vikramjit, Krishnan Sheila, Mercier Olaf, Miltiades Andrea N, Montani David, Murphy Edward, Robbins Ivan, Rahaghi Franck F, Saddoughi Sahar A, Savale Laurent, Simon Marc A, Vachiery Jean-Luc, Ventetuolo Corey E, Whitford Helen M, Girgis Reda E
University of California, San Francisco San Francisco California USA.
Alfred Hospital Melbourne Australia.
Pulm Circ. 2025 Apr 23;15(2):e70088. doi: 10.1002/pul2.70088. eCollection 2025 Apr.
Lung transplantation is indicated for selected patients with advanced pulmonary arterial hypertension (PAH). We used a modified Delphi process to develop recommendations on care of patients with PAH undergoing lung transplantation. This Delphi panel was recruited from the Pulmonary Vascular Research Institute's Innovative Drug Discovery Initiative - Lung Transplantation Workstream, consisting of clinical and research experts in PAH and lung transplantation. In this process, 29 panelists were given open-ended questions, querying topics related to lung transplantation in PAH. A steering group converted the responses into discrete statements. Panelists then rated agreement using a Likert scale in two further survey rounds: -5 (strongly disagree) to 5 (strongly agree). Consensus was defined as mean ≥ 2.5 or ≤ -2.5, with a standard deviation not crossing zero. Consensus was reached on 141 of 223 statements. Notable areas of consensus were for early discussions about transplantation, and agreement with previously published referral and listing criteria. There was agreement that lung transplantation could be offered in sick candidates, including those with concurrent renal or hepatic insufficiency. Bilateral lung transplantation was considered the procedure of choice for most patients, with rare indications for heart-lung transplantation. Consensus on bridging strategies included use of veno-arterial extracorporeal membrane oxygenation and preemptive awake cannulation in those with severe right ventricular dysfunction. Consensus was also achieved on intraoperative use of invasive hemodynamic monitoring, and prolonged postoperative circulatory support guided by hemodynamic response and echocardiography. Patients with PAH undergoing transplantation require specialized management, which differs somewhat from other candidates.
肺移植适用于部分晚期肺动脉高压（PAH）患者。我们采用改良德尔菲法，就PAH患者肺移植的护理制定建议。该德尔菲小组由肺血管研究所创新药物发现倡议组织——肺移植工作流招募，成员包括PAH和肺移植领域的临床及研究专家。在此过程中，29名小组成员被问及开放式问题，询问与PAH患者肺移植相关的话题。一个指导小组将这些回答转化为离散的陈述。然后，小组成员在另外两轮调查中使用李克特量表对同意程度进行评分：-5（强烈不同意）至5（强烈同意）。共识的定义为平均值≥2.5或≤ -2.5，标准差不超过零。223条陈述中有141条达成了共识。达成共识的显著领域包括关于移植的早期讨论，以及与先前公布的转诊和列入标准一致。大家一致认为，可以为病情严重的候选者提供肺移植，包括那些同时患有肾或肝功能不全的患者。双侧肺移植被认为是大多数患者的首选手术方式，心肺移植的适应症很少。关于桥接策略的共识包括对严重右心室功能障碍患者使用静脉-动脉体外膜肺氧合和预防性清醒插管。在术中使用有创血流动力学监测以及根据血流动力学反应和超声心动图进行术后长期循环支持方面也达成了共识。接受移植的PAH患者需要专门的管理，这与其他候选者有所不同。
