72例闭塞性细支气管炎的肺再次移植：生存预测因素

Seventy-two pulmonary retransplantations for obliterative bronchiolitis: predictors of survival.

作者信息

Novick R J, Schäfers H J, Stitt L, Andréassian B, Klepetko W, Hardesty R L, Frost A, Patterson G A

机构信息

Department of Surgery, University Hospital, London, Ontario, Canada.

出版信息

Ann Thorac Surg. 1995 Jul;60(1):111-6.

PMID:7598570

Abstract

BACKGROUND

Obliterative bronchiolitis (OB) occurs in up to 40% of patients in the intermediate term after lung transplantation. In recent years an increasing number of recipients with end-stage OB have been treated with retransplantation.

METHODS

Seventy-two patients with OB underwent retransplantation at 26 North American and European centers a median of 590 days after their first transplant operation. The predictors of survival were determined using life table and Cox proportional hazards methods, and the recurrence rate of OB was determined in survivors.

RESULTS

The actuarial survival rate was 71% +/- 5% at 1 month, 43% +/- 6% at 1 year, and 35% +/- 6% at 2 years; nonetheless, of the 90-day postoperative survivors, 63% +/- 7% were alive 2 years after retransplantation. Institutional experience with more than three pulmonary retransplantations (p = 0.008), reoperation in Europe (p = 0.013), donor-recipient ABO blood group identity (p = 0.018), and more recent year of retransplantation (p = 0.03) were associated with survival. On multivariate analysis, reoperation after 1989 (p < 0.001), retransplantation performed in Europe (p = 0.017), and being ambulatory immediately before reoperation (p = 0.022) were found to be predictive of a positive outcome. Pulmonary function test analyses confirmed that the forced expiratory volume in 1 second decreased from postoperative baseline values by 11% +/- 9% at 1 year and 27% +/- 10% at 2 years (p = 0.02; year 2 versus baseline). Fourteen percent of patients were in stage 3 of the bronchiolitis obliterans syndrome at 1 year postoperatively, with 33% affected at 2 years.

CONCLUSIONS

The results of pulmonary retransplantation for OB are improving. Current evidence indicates that OB does not recur in an accelerated manner after retransplantation, although pulmonary function does worsen again by 2 years. Pulmonary retransplantation is appropriate only in selected patients with OB who are ambulatory and are operated on at experienced centers.

摘要

背景

闭塞性细支气管炎（OB）在肺移植术后中期的患者中发生率高达40%。近年来，越来越多终末期OB患者接受了再次移植治疗。

方法

72例OB患者在北美和欧洲的26个中心接受了再次移植，首次移植手术后的中位时间为590天。使用生命表和Cox比例风险方法确定生存预测因素，并在幸存者中确定OB的复发率。

结果

术后1个月的精算生存率为71%±5%，1年时为43%±6%，2年时为35%±6%；尽管如此，术后90天的幸存者中，63%±7%在再次移植后2年仍存活。机构有超过3例肺再次移植的经验（p = 0.008）、在欧洲进行再次手术（p = 0.013）、供受者ABO血型相同（p = 0.018）以及更近的再次移植年份（p = 0.03）与生存相关。多变量分析显示，1989年后进行再次手术（p < 0.001）、在欧洲进行再次移植（p = 0.017）以及再次手术前能走动（p = 0.022）可预测良好结局。肺功能测试分析证实，术后1年第1秒用力呼气量较术后基线值下降11%±9%，2年时下降27%±10%（p = 0.02；第2年与基线相比）。术后1年，14%的患者处于闭塞性细支气管炎综合征3期，2年时为33%。