Bobba Christopher M, Saha Biplab, Stukov Yuriy, Kugler Liam, Aladaileh Mohammad A, Oduntan Olusola, Weir William, Jacobs Jeffrey P, Gries Cynthia, Emtiazjoo Amir, Rackauskas Mindaugas
Division of Thoracic Surgery, Department of Surgery, University of Florida, Gainesville, FL.
Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL.
JHLT Open. 2025 Mar 5;9:100241. doi: 10.1016/j.jhlto.2025.100241. eCollection 2025 Aug.
Lung transplantation (LTx) is performed as soon as donor organs are made available to minimize cold ischemic time. Studies have suggested that an extended static preservation of donor lung allografts at 10°C may offer similar clinical outcomes with the added benefits of surgery being performed as a semi-elective (SE) procedure. The purpose of our study was to compare the clinical outcomes between a cohort of patients who underwent LTx in the traditional fashion and after a period of static preservation at 10°C. Unlike previous studies, we also provide an account of the recipients' pre-transplant health status.
This is a prospective, nonrandomized, open label study with propensity matching. Controls were matched using a 2:1 greedy matching algorithm based on LAS within the timeframe of the study (2021-2023), resulting in 15 SE and 30 matched controls. In the SE arm, no LTx was performed between 1800 and 0500 hours. When donor lungs were accepted and the donor cross clamp time occurred between 1800 and 0400 hours, OR time (anesthesia start) was moved to 0600 or later. On arrival, donor lungs were stored at 10°C static preservation. The maximum allowed time between donor cross clamp and recipient anesthesia initiation was 12 hours.
No statistical difference between baseline characteristics was identified between the 2 groups (Table 1). 2/3 of patients were already admitted at the time of transplantation and 15% were on ECMO pre-operatively, indicating a sick patient cohort. Left lung ischemic time (performed second at our institution) was significantly longer in the SE group (722 minutes vs 318 minutes). Post-operative outcomes, including PGD at 72 hours, prolonged MV, ICU and hospital LOS, rejection, re-exploration, and re-admissions were not statistically different between the 2 groups. 1- year survival was 93% for SE patients, and 100% for controls.
One-year outcomes of semi-elective lung transplantation is comparable to traditional transplantation recipients, even in a sick cohort of patients.
一旦有供体器官可用，即进行肺移植（LTx），以尽量缩短冷缺血时间。研究表明，在10°C下对供体肺同种异体移植物进行延长的静态保存可能会带来相似的临床结果，且手术作为半择期（SE）手术还具有额外的益处。我们研究的目的是比较以传统方式接受LTx的患者队列与在10°C下进行一段时间静态保存后接受LTx的患者队列之间的临床结果。与以往研究不同的是，我们还描述了受者移植前的健康状况。
这是一项采用倾向匹配的前瞻性、非随机、开放标签研究。在研究时间范围内（2021 - 2023年），基于肺分配评分（LAS）使用2:1贪婪匹配算法对对照组进行匹配，结果有15例半择期患者和30例匹配的对照组。在半择期组中，18:00至05:00之间不进行LTx。当接受供体肺且供体阻断时间在18:00至04:00之间时，手术时间（麻醉开始时间）推迟到06:00或更晚。供体肺到达后，在10°C下进行静态保存。供体阻断与受者麻醉开始之间的最大允许时间为12小时。
两组之间的基线特征未发现统计学差异（表1）。2/3的患者在移植时已入院，15%的患者术前使用体外膜肺氧合（ECMO），表明这是一组病情较重的患者。半择期组左肺缺血时间（在我们机构中为第二次进行）明显更长（722分钟对318分钟）。两组之间的术后结果，包括72小时时的原发性移植肺功能障碍（PGD）、机械通气时间延长、重症监护病房（ICU）和住院时间、排斥反应、再次手术和再次入院等，均无统计学差异。半择期患者的1年生存率为93%，对照组为100%。
即使在病情较重的患者队列中，半择期肺移植的1年结果与传统移植受者相当。
