Wiebe K, Wahlers T, Harringer W, vd Hardt H, Fabel H, Haverich A
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Eur J Cardiothorac Surg. 1998 Aug;14(2):191-6. doi: 10.1016/s1010-7940(98)00163-8.
Colonization of the lung and mediastinal lymph nodes with multi-resistant bacteria, diabetes and malnutrition represent potential risk factors for lung transplantation in cystic fibrosis. We therefore reviewed our experience in this patient population.
Between December 1988 and March 1997, 219 lung and heart-lung transplantations were performed at our institution. Of these, 39 procedures were done in 35 patients with cystic fibrosis. All candidates (mean age 26 years) were oxygen dependent (preoperative mean PO2: 44.8 +/- 9.1 Torr, preoperative mean PCO2: 53.4 +/- 10.5 Torr, one patient on respirator). Of the primary operations, 34 were performed as bilateral sequential lung transplants, one as a heart-lung transplantation.
Mean duration on respirator for survivors was 3.1 (1-12) days, mean ICU and hospital stay were 4.7 (1-13) and 28 (12-79) days, respectively. The 3-month mortality rate was 5.7% (two patients died due to acute graft failure on days 36 and 73). Other causes of death in the follow-up were cerebral bleeding (one patient) and chronic graft failure (three patients). The survival rates were 91% at 1 year, 83% at 3 years and 76% at 5 years. In eight patients, a bronchiolitis obliterans syndrome (BOS) developed (in four cases grade 3). The freedom of BOS (grade 1 or more) at 1, 3 and 5 years was 87, 79 and 55%, respectively. Four retransplantations were performed. Of the 29 patients alive, only seven are physically limited.
Bilateral lung transplantation for cystic fibrosis allows for acceptable early- and long-term results. Postoperative survival is not impaired by infection, diabetes and malnutrition. Long-term functional outcome seems to be comparable to lung transplantation in patients without infectious pulmonary disease.
肺部和纵隔淋巴结被多重耐药菌定植、糖尿病及营养不良是囊性纤维化患者肺移植的潜在危险因素。因此，我们回顾了我们在这一患者群体中的经验。
1988年12月至1997年3月期间，我们机构进行了219例肺移植和心肺移植手术。其中，35例囊性纤维化患者接受了39例手术。所有候选者（平均年龄26岁）均依赖氧气（术前平均动脉血氧分压：44.8±9.1 Torr，术前平均动脉血二氧化碳分压：53.4±10.5 Torr，1例患者使用呼吸机）。在初次手术中，34例为双侧序贯肺移植，1例为心肺移植。
存活者的平均呼吸机使用时间为3.1（1 - 12）天，平均重症监护病房（ICU）停留时间和住院时间分别为4.7（1 - 13）天和28（12 - 79）天。3个月死亡率为5.7%（2例患者分别于第36天和第73天因急性移植物功能衰竭死亡）。随访期间的其他死亡原因包括脑出血（1例患者）和慢性移植物功能衰竭（3例患者）。1年、3年和5年生存率分别为91%、83%和76%。8例患者发生了闭塞性细支气管炎综合征（BOS）（4例为3级）。1年、3年和5年时无BOS（1级或以上）的比例分别为87%、79%和55%。进行了4例再次移植。在29例存活患者中，只有7例身体功能受限。
囊性纤维化患者的双侧肺移植可获得可接受的早期和长期结果。感染、糖尿病和营养不良不会影响术后生存率。长期功能结果似乎与无感染性肺部疾病患者的肺移植相当。
