单中心50例肺移植临床特点分析

目的分析总结肺移植受者围手术期特点，增加肺移植管理经验。 方法回顾性分析中日友好医院呼吸中心2017年3月1日至12月31日完成的50例脑死亡器官捐献肺移植手术临床资料，受者中位年龄63岁(27～71岁)，男性43例，女性7例；单肺移植31例，双肺移植19例。38例供者中位年龄37岁(16～55岁)，捐献前氧合指数中位数为444 mmHg(313～600 mmHg，1 mmHg＝0.133 kPa)。供受者ABO血型均相合。采用卡方检验或Fisher确切概率法比较不同年龄、性别、术式、体质指数、原发病和术中出血量以及是否应用体外膜肺氧合(ECMO)的受者围手术期死亡比例，两两比较采用Bonferroni法调整α水平。采用Kaplan-Meier法绘制受者术后1年生存曲线，并采用Breslow检验比较两组受者生存曲线是否有差异。P<0.05为差异有统计学意义。 结果50例肺移植受者中，40例围手术期应用ECMO中位辅助时间为2.0 d(0.3 d～13.0 d)。气管插管呼吸机辅助中位时间为2 d(1～16 d)，ICU停留中位时间为4 d(1～60 d)。50例受者中有8例于围手术期死亡，存活时间1～49 d。双肺移植和单肺移植受者围手术期死亡比例分别为31.6%(6/19)、6.5%(2/31)，差异有统计学意义(P＝0.041)。随访至肺移植术后1年，50例受者存活39例。单肺移植受者术后1年生存率高于双肺移植，分别为87.1%和63.2%，差异有统计学意义(P<0.05)。不同年龄、原发病以及有无ECMO支持的受者术后1年生存率差异均有统计学意义(P均<0.05)。50例肺移植受者中10例发生供者来源感染；9例术后出现气道并发症，均表现为支气管狭窄，其中2例合并吻合口瘘。 结论选择合适时机行肺移植，并对受者进行围手术期全面综合评估和管理，才能使受者最终受益。

A single-center experience of 50 cases of adult lung transplantation

ObjectiveTo analyze the perioperative characteristics of lung transplantation (LT) recipients, and to enhance the experience of LT. MethodsThe clinical data on 50 consecutive brain-dead donor at Lung Transplantation Center of China-Japan Friendship Hospital from March 1 to December 31, 2017 were retrospectively collected. The median age of recipients was 63 years (27-71 years), including 43 males and 7 females. Thirty-one single LT (SLT) recipients and 19 bilateral LT (BLT) recipients were enrolled. Thirty-eight donors′ age was between 16 to 55 years (median age 37 years). Median PaO₂/FiO₂ was 444 mmHg (313-600 mmHg, 1 mmHg=0.133 kPa) before donation with ABO compatibility between all donors and recipients. We used Chi-square test or Fisher exact test to compare the perioperative death rate between different groups of age, sex, procedure type, body mass index, primary diseases, blood loss and extracorporeal membrane oxygenation (ECMO) support. Bonferroni method was used to adjust α level in pairwise comparison. Overall survivals of different groups at one year were described by using Kaplan-Meier curves, and Breslow test was used to compare the survival curve between the two groups. A P<0.05 was considered statistically significant. ResultsMedian perioperative ECMO support time was 2.0 d (0.3 d-13.0 d) in 40 recipients. Median ICU stay time was 4 d (1-60 d). Perioperative survival rate was 84%(42/50), with survival time being 1-49 d in 8 recipients. Perioperative survival rates in BLT and SLT were 31.6% (6/19) and 6.5% (2/31), respectively (P=0.041). One year survival rate in all recipients was 78% (39/50), while it was 87.1% in SLT and 63.2% in BLT, respectively (P<0.05). There were different Kaplan-Meier curves in subgroup of age, primary diseases and ECMO support (P all <0.05). Ten recipients (20%) had donor derived infection. Nine patients (18%) developed airway complications with bronchial stenosis following LT, which 2 patients complicated with anastomotic fistula. ConclusionPatients with end-stage lung disease can benefit from LT at appropriate time point and comprehensive appreciation and management.