Wahlers T, Haverich A, Schäfers H J, Hirt S W, Fieguth H G, Jurmann M, Zink C, Borst H G
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Eur J Cardiothorac Surg. 1993;7(6):319-23; discussion 324. doi: 10.1016/1010-7940(93)90174-a.
The long-term prognosis following lung transplantation (LTX) depends mainly on the development of chronic rejection which appears clinically as deterioration of the lung function while, histologically, obliterative bronchiolitis (OB) is found. However, it still remains questionable whether heart-lung (HL), double or single lung (DL/SL) transplants behave similarly with regard to incidence and time pattern. Eighty-two patients, transplanted until August 92, were analyzed. Early and late deaths within 180 days postoperatively were excluded. A total of 64 patients at risk could be evaluated. By repeated lung function tests, obstructive airway disease was defined by a drop of 25% or more of the forced expiratory volume in one second (FEV1) in percent of the inspiratory vital capacity.
The functional optimum after transplantation was reached after a comparable time-span postoperatively in all groups. Chronic deterioration of the lung function developed earlier following DLTX compared to HLTX and SLTX. Obstructive airway disease was diagnosed in 9/20 (45%) HL, 7/19 (37%) DL, and 7/25 (28%) SL patients. Of these, 4 died and 4 had to be retransplanted for the disease while an additional 15 patients are currently under investigation. It is concluded that the development of obstructive airway disease represents a serious problem in all types of lung transplantation. There is a tendency to earlier development following DLTX--perhaps caused by the greatest immunological potential in this group of patients.
肺移植（LTX）后的长期预后主要取决于慢性排斥反应的发展，临床上表现为肺功能恶化，而组织学上则发现闭塞性细支气管炎（OB）。然而，心肺（HL）、双肺或单肺（DL/SL）移植在发病率和时间模式方面是否表现相似仍存在疑问。对截至1992年8月接受移植的82例患者进行了分析。排除术后180天内的早期和晚期死亡病例。共有64例有风险的患者可供评估。通过重复肺功能测试，阻塞性气道疾病的定义为一秒用力呼气量（FEV1）较吸气肺活量下降25%或更多。
所有组在术后相当的时间跨度后达到移植后的功能最佳状态。与HLTX和SLTX相比，DLTX后肺功能的慢性恶化出现得更早。在HL组的20例患者中有9例（45%）、DL组的19例患者中有7例（37%）、SL组的25例患者中有7例（28%）被诊断为阻塞性气道疾病。其中，4例死亡，4例因该疾病不得不再次移植，另有15例患者目前正在接受调查。结论是，阻塞性气道疾病的发展在所有类型的肺移植中都是一个严重问题。DLTX后有更早出现的趋势——可能是由该组患者最大的免疫潜能引起的。
