患有闭塞性细支气管炎的心肺移植和双侧序贯肺移植受者的精算生存率。

Actuarial survival of heart-lung and bilateral sequential lung transplant recipients with obliterative bronchiolitis.

作者信息

Valentine V G, Robbins R C, Berry G J, Patel H R, Reichenspurner H, Reitz B A, Theodore J

机构信息

Ochsner Transplant Center, New Orleans, La 70121, USA.

出版信息

J Heart Lung Transplant. 1996 Apr;15(4):371-83.

PMID:8732596

Abstract

BACKGROUND

Obliterative bronchiolitis is a progressive form of obstructive airway disease that threatens long-term survival in lung transplant recipients. Its incidence and the long-term survival of lung transplant recipients with obliterative bronchiolitis are unknown.

METHODS

The results of 89 heart-lung and 13 bilateral sequential lung transplant survivors beyond 90 days of their operation were analyzed. The date of diagnosis for obliterative bronchiolitis was established histologically (presence of submucosal fibrosis) or physiologically by a persistent reduction in the forced vital capacity to less than 0.7 for greater than 6 weeks. There were 43 patients without obliterative bronchiolitis and 59 patients with obliterative bronchiolitis.

RESULTS

No differences were found in the mean age and gender ratios between the two groups. The actuarial 1-, 5-, and 10-year percentage freedom from obliterative bronchiolitis was 72 +/- 4.6, 30 +/- 5.6, and 15 +/- 7.4, respectively, with a median onset of 689 days (range 55 to 3404 days). About half the patients with biopsy-proven obliterative bronchiolitis had a fall in their forced expiratory flow at 50% of forced vital capacity/forced vital capacity nearly 4 months before fulfilling the forced expiratory volume in 1 second criteria established by the Working Group on chronic lung dysfunction. The actuarial 1-, 5-, and 10-year percentage survival of obliterative bronchiolitis negative patients was 90 +/- 4.5, 74 +/- 8.4, and 66 +/- 10.6, respectively, versus 90 +/- 3.9, 49 +/- 6.9, and 27 +/- 10.0, respectively, for obliterative bronchiolitis positive patients (p = 0.38). The actuarial 1-, 3-, 5-, 8-, and 10-year percentage survival of lung transplant recipients after the diagnosis of obliterative bronchiolitis was 74 +/- 5.8, 50 +/- 7.5, 43 +/- 7.8, 23 +/- 8.7, and 11 +/- 9.1, respectively, with a median survival of 1084 days (range 0 to 3442 days).

CONCLUSIONS

The forced expiratory flow at 50% of forced vital capacity/forced vital capacity is a more sensitive indicator for the early detection of obliterative bronchiolitis than the forced expiratory volume in 1 second after heart-lung or bilateral sequential lung transplantation. The obliterative bronchiolitis negative group survival tends to be better than the obliterative bronchiolitis positive group. The obliterative bronchiolitis positive lung transplant recipients have reasonable outcomes with a median survival time of nearly 3 years after the diagnosis of obliterative bronchiolitis. Earlier detection of obliterative bronchiolitis and refinements in management may further improve these results.

摘要

背景

闭塞性细支气管炎是一种进行性阻塞性气道疾病，威胁着肺移植受者的长期生存。其发病率以及患有闭塞性细支气管炎的肺移植受者的长期生存率尚不清楚。

方法

分析了89例心肺联合移植和13例双侧序贯肺移植术后存活超过90天患者的结果。闭塞性细支气管炎的诊断日期通过组织学（存在黏膜下纤维化）或生理学方法确定，即用力肺活量持续降低至小于0.7并持续超过6周。其中43例患者无闭塞性细支气管炎，59例患者患有闭塞性细支气管炎。

结果

两组之间的平均年龄和性别比例无差异。闭塞性细支气管炎的精算1年、5年和10年无病生存率分别为72±4.6%、30±5.6%和15±7.4%，中位发病时间为689天（范围55至3404天）。约一半经活检证实患有闭塞性细支气管炎的患者，在达到慢性肺功能障碍工作组制定的1秒用力呼气量标准前近4个月，其50%用力肺活量时的用力呼气流量/用力肺活量就已下降。闭塞性细支气管炎阴性患者的精算1年、5年和10年生存率分别为90±4.5%、74±8.4%和66±10.6%，而闭塞性细支气管炎阳性患者分别为90±3.9%、49±6.9%和27±10.0%（p = 0.38）。闭塞性细支气管炎诊断后，肺移植受者的精算1年、3年、5年、8年和10年生存率分别为74±5.8%、50±7.5%、43±7.8%、23±8.7%和11±9.1%，中位生存期为1084天（范围0至3442天）。

结论

对于心肺联合移植或双侧序贯肺移植术后早期检测闭塞性细支气管炎，50%用力肺活量时的用力呼气流量/用力肺活量比1秒用力呼气量更敏感。闭塞性细支气管炎阴性组的生存率往往优于阳性组。闭塞性细支气管炎阳性的肺移植受者预后合理，诊断闭塞性细支气管炎后的中位生存时间近3年。更早检测出闭塞性细支气管炎并优化管理可能会进一步改善这些结果。