Bavaria J E, Kotloff R, Palevsky H, Rosengard B, Roberts J R, Wahl P M, Blumenthal N, Archer C, Kaiser L R
Department of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, USA.
J Thorac Cardiovasc Surg. 1997 Mar;113(3):520-7; discussion 528. doi: 10.1016/S0022-5223(97)70365-9.
Traditionally, despite ventilation/perfusion mismatch, single lung transplantation has been the mainstay for end-stage chronic obstructive pulmonary disease. We tested the hypothesis that bilateral sequential lung transplantation has better short- and intermediate-term results than single lung transplantation for chronic obstructive pulmonary disease.
One hundred twenty-six consecutive lung transplants have been performed from November 1991 to March 1996. Seventy-six have been for chronic obstructive pulmonary disease. The diagnosis of this disease includes emphysema (80.3%), alpha 1-antitrypsin deficiency (9.2%), lymphangioleiomyomatosis (7.9%), and obliterative bronchiolitis (2.6%). Twenty-nine transplants have been bilateral and 47 have been single. Mean age was 55.3 for patients having single lung transplantation and 48.8 for those having bilateral lung transplantation (p = 0.001). The distribution of the diagnoses was similar between the two groups. At 6 months, there were 29 survivors of single lung transplantation and 20 survivors of bilateral lung transplantation, with complete data for evaluation. Pulmonary function tests and 6-minute walk tests were evaluated at a mean of 15.4 and 12.8 months after transplantation, respectively.
Sixty-day mortality was 21.3% for single lung transplantation versus only 3.45% for bilateral lung transplantation (p = 0.03). Additionally, Kaplan-Meier analysis revealed 1- and 2-year survivals of 71.1% and 63.3% for single lung transplantation versus 90% and 90% for bilateral lung transplantation, respectively. Multiple major morbidities were analyzed. Primary graft failure was significantly reduced in the bilateral group (p = 0.049). Both 6-minute walk tests and forced expiratory volume in 1 second were improved from baseline by both single and bilateral lung transplantation (p = 0.001).
Bilateral lung transplantation improves forced expiratory volume in 1 second and 6-minute walk tests significantly over single lung transplantation (p < 0.0001). Both perioperative mortality and Kaplan-Meier survival (to 3 years) are significantly improved when bilateral rather than single lung transplantation is used for chronic obstructive pulmonary disease in our series (p < 0.05). This is probably the result of significantly reduced primary graft failure.
传统上，尽管存在通气/灌注不匹配，但单肺移植一直是终末期慢性阻塞性肺疾病的主要治疗方法。我们检验了这样一个假设，即对于慢性阻塞性肺疾病，双侧序贯肺移植比单肺移植具有更好的短期和中期效果。
1991年11月至1996年3月共进行了126例连续的肺移植手术。其中76例是针对慢性阻塞性肺疾病。该疾病的诊断包括肺气肿（80.3%）、α1抗胰蛋白酶缺乏症（9.2%）、淋巴管平滑肌瘤病（7.9%）和闭塞性细支气管炎（2.6%）。29例为双侧肺移植，47例为单肺移植。单肺移植患者的平均年龄为55.3岁，双侧肺移植患者的平均年龄为48.8岁（p = 0.001）。两组的诊断分布相似。在6个月时，单肺移植有29例存活者，双侧肺移植有20例存活者，有完整的数据用于评估。分别在移植后平均15.4个月和12.8个月时评估肺功能测试和6分钟步行测试。
单肺移植的60天死亡率为21.3%，而双侧肺移植仅为3.45%（p = 0.03）。此外，Kaplan-Meier分析显示，单肺移植的1年和2年生存率分别为71.1%和63.3%，而双侧肺移植分别为90%和90%。分析了多种主要并发症。双侧组的原发性移植物功能衰竭明显减少（p = 0.049）。单肺移植和双侧肺移植后的6分钟步行测试和第1秒用力呼气量均较基线有所改善（p = 0.001）。
与单肺移植相比，双侧肺移植显著改善了第1秒用力呼气量和6分钟步行测试结果（p < 0.0001）。在我们的系列研究中，对于慢性阻塞性肺疾病，采用双侧肺移植而非单肺移植时，围手术期死亡率和Kaplan-Meier生存率（至3年）均显著提高（p < 0.05）。这可能是原发性移植物功能衰竭显著减少的结果。
