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单中心使用心脏死亡肺捐赠者行肺移植术的经验积累

[日期:2012-08-09] 来源:  作者: [字体: ]

      因为对器官质量下降的认识不足,目前心脏死亡捐赠者(donors of cardiac death, DCD)器官应用于肺移植(lung transplantation,LTx)经验尚不足,但DCD器官用于LTx很有前景。一些医学中心认为由于DCD肺移植风险高,推荐在移植前做离体评估。Mason(克利夫兰诊所心胸外科, USA)等人分析了其所在医学中心采用脑死亡捐赠者方案获得和移植DCD肺的经验。(Ann Thorac Surg. 2012 Aug;94(2):406-12)

      他们的研究纳入了2004年8月至2011年7月间605例进行LTx的患者。其中,32例(4.9%)使用DCD的肺器官。他们采用脑死亡捐献者标准化方案进行捐献者选择、器官获取和器官保存。观察的结局有Kaplan-Meier生存曲线、通过PO 2/FIO 2 比[P/F 比]衡量的移植物早期功能、气道并发症、肺功能以及闭塞性细支气管炎综合症(bronchiolitis obliterans syndrome,BOS)的发生情况。

研究结果显示,30天生存率率为97%,1年生存率为91%,2年生存率为91%,3年、4年生存率为71%。6小时P/F均值为305,24小时P/F均值为332。1位患者的气道并发症需要进行干预。拔管、ICU住院时间、总住院时间的中位值分别为1天、4天和14天。在中位随访的2.8年中,患者第1秒用力呼气量以及预测值百分比 (FEV1%)分别为59% (27%–113%),其中16% (5/32)患者有BOS。

      因此,他们的研究表明,使用DCD肺的患者生存率及早期移植肺功能都令人满意,并且在获取、保存或者移植方案中不需要做明显的调整,且不需担忧器官质量下降的问题,可以进行推广。

摘要原文:

Growing Single-Center Experience With Lung Transplantation Using Donation After Cardiac Death

Background: Early experience with lung transplantation (LTx) using organs from donors after cardiac death (DCD) has been promising, although widespread adoption has been slow because of the perception of diminished organ quality. Some centers have even suggested that use of DCD lungs is high risk and have recommended ex vivo evaluation before transplantation. We analyzed our growing single-center experience with DCD lungs procured and transplanted using protocols established for brain-dead donors.

Methods: From August 2004 to July 2011, 605 patients underwent LTx, 32 (4.9%) with DCD organs. Standardized donor selection, procurement, and preservation protocols established for brain-dead donors were applied to DCD organs. Measured outcomes were Kaplan-Meier survival, early graft function measured by arterial partial pressure of oxygen/fraction of inspired oxygen (PO 2/FIO 2 ratio [P/F ratio]), airway complications, spirometry, and development of bronchiolitis obliterans syndrome (BOS).

Results: Survival was 97% at 30 days, 91% at 1 year, 91% at 2 years, and 71% at 3 and 4 years. Mean P/F ratio at 6 hours and 24 hours was 305 and 332, respectively. One airway complication required intervention. Median time to extubation, intensive care unit (ICU), and total hospital lengths of stay were 1, 4, and 14 days, respectively. At median follow-up of 2.8 years, median forced expiratory volume in 1 second, percent of predicted (FEV1%) of the survivors was 59% (range, 27%–113%), with 16% (5/32) having BOS.

Conclusions: This growing experience suggests that recipient survival and early graft function using DCD lungs is excellent and has occurred without significant adjustment of procurement, preservation, or implantation protocols. Concerns over diminished organ quality are unfounded, and use of DCD lungs should be expanded.

Links: http://ats.ctsnetjournals.org/cgi/content/abstract/94/2/406

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