瑞典隆德大学医院肺移植术后25年随访：囊性纤维化患者取得更好结果。
25-year follow-up after lung transplantation at Lund University Hospital in Sweden: superior results obtained for patients with cystic fibrosis.
作者信息
Fakhro Mohammed, Ingemansson Richard, Skog Ingrid, Algotsson Lars, Hansson Lennart, Koul Bansi, Gustafsson Ronny, Wierup Per, Lindstedt Sandra
机构信息
Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
Department of Pulmonary Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
出版信息
Interact Cardiovasc Thorac Surg. 2016 Jul;23(1):65-73. doi: 10.1093/icvts/ivw078. Epub 2016 Apr 6.
OBJECTIVES
In Sweden, two centres perform lung transplantation for a population of about 9 million and the entire population is covered for lung transplantation by government health insurance. Lund University Hospital is one of these centres. This retrospective report reviews the 25-year experience of the Skåne University Hospital Lung Transplant Program with particular emphasis on short-term outcome and long-term survival but also between different subgroups of patients and types of transplant [single-lung transplantation (SLTx) versus double-lung transplantation (DLTx)] procedure performed.
METHODS
Between January 1990 and June 2014, 278 patients underwent lung transplantation at the Skåne University Hospital Sweden. DLTx was performed in 172 patients, SLTx was performed in 97 patients and heart-lung transplantation was performed in 9 patients. In addition, 15 patients required retransplantation (7 DLTx and 8 SLTx).
RESULTS
Overall 1-, 5-, 10-, 15- and 20-year survival rates were 88, 65, 49, 37 and 19% for the whole cohort. DLTx recipients showed 1-, 5-, 10- and 20-year survival rates of 90, 71, 60 and 30%, compared with SLTx recipients with 1-, 5-, 10- and 20-year survival rates of 83, 57, 34 and 6% (P < 0.05), respectively. Comparing the use of intraoperative extracorporeal membrane oxygenation, extracorporeal circulation (ECC) and no circulatory support in the aspect of survival, a significant difference in favour of intraoperative ECC was seen.
CONCLUSIONS
Superior long-term survival rates were seen in recipients diagnosed with cystic fibrosis, α1-antitrypsin deficiency and pulmonary hypertension. DLTx showed better results compared with SLTx especially at 10 years post-transplant. In the present study, we present cumulative incidence rates of bronchiolitis obliterans syndrome of 15% at 5 years, 26% at 10 years and 32% at 20 years post-transplant; these figures are in line with the lowest rates presented internationally.
目的
在瑞典，两个中心为约900万人口实施肺移植手术，且政府医疗保险覆盖了全体人口的肺移植需求。隆德大学医院是其中一个中心。本回顾性报告回顾了斯科讷大学医院肺移植项目25年的经验，特别强调短期结局和长期生存率，同时也涉及不同患者亚组以及所实施的移植类型（单肺移植[SLTx]与双肺移植[DLTx]）之间的差异。
方法
1990年1月至2014年6月期间，瑞典斯科讷大学医院有278例患者接受了肺移植手术。172例患者接受了双肺移植，97例患者接受了单肺移植，9例患者接受了心肺移植。此外，15例患者需要再次移植（7例双肺移植和8例单肺移植）。
结果
整个队列的1年、5年、10年、15年和20年总生存率分别为88%、65%、49%、37%和19%。双肺移植受者的1年、5年、10年和20年生存率分别为90%、71%、60%和30%，相比之下，单肺移植受者的1年、5年、10年和20年生存率分别为83%、57%、34%和6%（P<0.05）。在生存方面比较术中体外膜肺氧合、体外循环（ECC）和无循环支持的使用情况，发现有利于术中ECC的显著差异。
结论
被诊断为囊性纤维化、α1-抗胰蛋白酶缺乏症和肺动脉高压的受者具有较高的长期生存率。双肺移植与单肺移植相比显示出更好的结果，尤其是在移植后10年。在本研究中，我们给出了移植后5年闭塞性细支气管炎综合征累积发病率为15%，10年为26%，20年为32%；这些数字与国际上公布的最低发病率一致。
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