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

doi:10.3877/cma.j.issn.1674-3903.2020.06.003

Abstract

Abstract:

Objective

To analyze the perioperative characteristics of lung transplantation (LT) recipients, and to enhance the experience of LT.

Methods

The 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.

Results

Median 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.

Conclusion

Patients with end-stage lung disease can benefit from LT at appropriate time point and comprehensive appreciation and management.

Key words: Lung transplantation, Perioperative management, Survival rate

Wenhui Chen, Lijuan Guo, Li Zhao, Chaoyang Liang, Qingyuan Zhan, Min Li, Run Tong, Qianli Ma, Huaping Dai, Jingyu Chen, Chen Wang. A single-center experience of 50 cases of adult lung transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2020, 14(06): 349-354.

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Figures/Tables 5

References 24

1	Chambers DC, Cherikh WS, Goldfarb SB, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth adult lung and heart-lung transplant report-2018; Focus theme: Multiorgan transplantation[J]. J Heart Lung Transplant, 2018, 37(10): 1169-1183.
2	Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014 - an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation[J]. J Heart Lung Transplant, 2015, 34(1): 1-15.
3	Valapour M, Lehr CJ, Skeans MA, et al. OPTN/SRTR 2016 annual data report: Lung[J]. Am J Transplant, 2018, 18(Suppl 1): 363-433.
4	Gray AL, Mulvihill MS, Hartwig MG. Lung transplantation at Duke[J]. J Thorac Dis, 2016, 8(3): E185-E196.
5	Brown AW, Kaya H, Nathan SD. Lung transplantation in IIP: A review[J]. Respirology, 2016, 21(7): 1173-1184.
6	Nathan SD, Shlobin OA, Ahmad S, et al. Comparison of wait times and mortality for idiopathic pulmonary fibrosis patients listed for single or bilateral lung transplantation[J]. J Heart Lung Transplant, 2010, 29(10): 1165-1171.
7	De Oliveira Nilto C, Osaki Satoru, Maloney James, et al. Lung transplant for interstitial lung disease: outcomes for single versus bilateral lung transplantation[J]. Interact Cardiovasc Thorac Surg, 2012, 14(3): 263-267.
8	Schaffer JM, Singh SK, Reitz BA, et al. Single- vs double-lung transplantation in patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis since the implementation of lung allocation based on medical need[J]. JAMA, 2015, 313(9): 936-948.
9	Raghu G, Rochwerg B, Zhang Y, et al. An official ATS/ERS/JRS/ALAT clinical practice guideline: Treatment of idiopathic pulmonary fibrosis. An update of the 2011 clinical practice guideline[J]. Am J Respir Crit Care Med, 2015, 192(2): e3-e19.
10	Stjarne Aspelund A, Hammarstrom H, Inghammar M, et al. Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden[J]. Transpl Infect Dis, 2018, 20(6): e12973.
11	Parada MT, Alba A, Sepúlveda C. Early and late infections in lung transplantation patients[J]. Transplant Proc, 2010, 42(1): 333-335.
12	Maurer JR, Tullis DE, Grossman RF, et al. Infectious complications following isolated lung transplantation[J]. Chest, 1992, 101(4): 1056-1059.
13	Aguilar-Guisado M, Givalda J, Ussetti P, et al. Pneumonia after lung transplantation in the RESITRA Cohort: a multicenter prospective study[J]. Am J Transplant, 2007, 7(8): 1989-1996.
14	Fishman JA. Infection in solid-organ transplant recipients[J]. N Engl J Med, 2007, 357(25): 2601-2614.
15	Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation[J]. Am J Respir Crit Care Med, 2004, 170(1): 22-48.
16	Riera J, Caralt B, López I, et al. Ventilator-associated respiratory infection following lung transplantation[J]. Eur Respir J, 2015, 45(3): 726-737.
17	Kotloff RM, Thabut G. Lung transplantation[J]. Am J Respir Crit Care Med, 2011, 184(2): 159-171.
18	Bonvillain RW, Valentine VG, Lombard G, et al. Post-operative infections in cystic fibrosis and non-cystic fibrosis patients after lung transplantation[J]. J Heart Lung Transplant, 2007, 26(9): 890-897.
19	Nunley DR, Bauldoff GS, Mangino JE, et al. Mortality associated with Acinetobacter baumannii infections experienced by lung transplant recipients[J]. Lung, 2010, 188(5): 381-385.
20	Howell CK, Paciullo CA, Lyon GM, et al. Effect of positive perioperative donor and recipient respiratory bacterial cultures on early post-transplant outcomes in lung transplant recipients[J]. Transpl Infect Dis, 2017, 19(6): e12760.
21	Bonde PN, Patel ND, Borja MC, et al. Impact of donor lung organisms on post-lung transplant pneumonia[J]. J Heart Lung Transplant, 2006, 25(1): 99-105.
22	Tanaka S, Geneve C, Tebano G, et al. Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation[J]. BMC Pulm Med, 2018, 18(1): 43.
23	Mahajan AK, Folch E, Khandhar SJ, et al. The diagnosis and management of airway complications following lung transplantation[J]. Chest, 2017, 152(3): 627-638.
24	Crespo MM, McCarthy DP, Hopkins PM, et al. ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics[J]. J Heart Lung Transplant, 2018, 37(5): 548-563.

因素	亚组	例数	死亡比例[例(%)]	P值
年龄(岁)				0.029
	<35	3	2(67)	0.042(与35～65岁比较)
	35～65	34	3( 9)	0.326(与>65比较)
	>65	13	3(23)	0.214(与<35岁比较)
性别	男性	43	6(14)	0.310
	女性	7	2(29)
肺移植术式	单肺	31	2( 6)	0.041
	双肺	19	6(32)
BMI(kg/m²)				0.314
	<18.5	13	4(31)
	18.5～30.0	36	4(11)
	>30.0	1	0( 0)
原发病				0.014
	ILD	35	4(11)	1.000(与COPD比较)
	COPD	8	0( 0)	0.026(与其他比较)
	其他	7	4(57)	0.017(与ILD比较)
ECMO支持	有	40	8(20)	0.184
	无	10	0( 0)
术中出血量(mL)	<1 000	43	3( 7)	0.071
	≥1 000	7	5(71)

因素	亚组	例数	死亡比例[例(%)]	P值
年龄(岁)				0.029
	<35	3	2(67)	0.042(与35～65岁比较)
	35～65	34	3( 9)	0.326(与>65比较)
	>65	13	3(23)	0.214(与<35岁比较)
性别	男性	43	6(14)	0.310
	女性	7	2(29)
肺移植术式	单肺	31	2( 6)	0.041
	双肺	19	6(32)
BMI(kg/m²)				0.314
	<18.5	13	4(31)
	18.5～30.0	36	4(11)
	>30.0	1	0( 0)
原发病				0.014
	ILD	35	4(11)	1.000(与COPD比较)
	COPD	8	0( 0)	0.026(与其他比较)
	其他	7	4(57)	0.017(与ILD比较)
ECMO支持	有	40	8(20)	0.184
	无	10	0( 0)
术中出血量(mL)	<1 000	43	3( 7)	0.071
	≥1 000	7	5(71)

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