肺移植治疗囊性纤维化后与死亡率相关的移植前因素：系统评价和荟萃分析。
Pre-transplant factors associated with mortality after lung transplantation in cystic fibrosis: A systematic review and meta-analysis.
机构信息
Division of Respirology, Department of Medicine, Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of Respirology, Adult Cystic Fibrosis Centre, St. Michael's Hospital, Toronto, ON, Canada; Division of Respiratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
Division of Respirology, Department of Medicine, Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada.
出版信息
J Cyst Fibros. 2019 May;18(3):407-415. doi: 10.1016/j.jcf.2018.10.013. Epub 2018 Oct 25.
BACKGROUND
Mortality risk stratification is essential in lung transplantation (LTx) to allow listing, prioritization and mitigating strategies. In cystic fibrosis (CF) patients, predictors of post-LTx mortality are not established.
METHODS
For this systematic review and meta-analysis, seven databases were searched until January 3, 2018 to identify predictors of post-LTx mortality in CF. We excluded studies of multi-organ transplantation, re-transplantation and graft survival. For multiple studies assessing the same population during overlapping time-periods, the largest one was analyzed. Risk of bias was assessed with the Newcastle-Ottawa scale (NOS). Pooled hazard ratios were calculated using random-effects models.
RESULTS
Fifty-four studies were included in the systematic review and 11 studies in the meta-analyses (low-to-moderate bias risk, NOS score ≥ 5). Among 10 factors assessed in the meta-analysis, B. cepacia complex (BCC) (N = 1451, unadjusted HR = 2.35, 95%CI:1.80-3.06; I = 20.4% and adjusted HR = 2.49, 95%CI:1.74-3.57; I = 46.2%) and ascending chronological year of LTx (N = 4207, unadjusted HR = 0.98, 95%CI:0.97-0.98, I = 4.8%) were predictors of post-LTx mortality. Male gender (N = 2903, adjusted HR = 1.12, 95%CI:1.0-1.26, I = 0%) and age in adults (N = 3677, unadjusted HR = 0.99, 95%CI:0.97-1.00; I = 64.1% and N = 2605, adjusted HR = 0.98, 95%CI:0.97-0.99; I = 34.3%) had borderline significant associations with post-LTx mortality. P. aeruginosa colonization, forced expiratory volume in one second (FEV), pulmonary hypertension, body mass index (BMI), pancreatic insufficiency and CF-related diabetes (CFRD) were not predictors of mortality.
CONCLUSIONS
BCC was associated with a higher post-LTx mortality whereas FEV, pulmonary hypertension, BMI, CFRD and female gender were not associated with post-LTx mortality. These findings indicate that CF-specific risk estimates of post-LTx mortality should be considered.
背景
在肺移植（LTx）中，死亡率风险分层对于进行列表排序、确定优先级和采取缓解策略至关重要。然而，在囊性纤维化（CF）患者中，尚没有明确的 LTx 后死亡率预测因素。
方法
本系统评价和荟萃分析检索了 7 个数据库，检索时间截至 2018 年 1 月 3 日，旨在确定 CF 患者 LTx 后死亡率的预测因素。我们排除了多器官移植、再次移植和移植物存活率的研究。对于在重叠时间段内评估同一人群的多项研究，仅分析最大的研究。使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。使用随机效应模型计算合并的风险比。
结果
系统评价共纳入 54 项研究，荟萃分析纳入 11 项研究（低至中度偏倚风险，NOS 评分≥5）。在荟萃分析中评估的 10 个因素中，洋葱伯克霍尔德菌复合群（BCC）（N=1451，未调整的 HR=2.35，95%CI：1.80-3.06；I²=20.4%和调整后的 HR=2.49，95%CI：1.74-3.57；I²=46.2%）和 LTx 逐年递增（N=4207，未调整的 HR=0.98，95%CI：0.97-0.98，I²=4.8%）是 LTx 后死亡率的预测因素。男性（N=2903，调整后的 HR=1.12，95%CI：1.0-1.26，I²=0%）和成年人的年龄（N=3677，未调整的 HR=0.99，95%CI：0.97-1.00；I²=64.1%和 N=2605，调整后的 HR=0.98，95%CI：0.97-0.99；I²=34.3%）与 LTx 后死亡率呈边缘显著相关。铜绿假单胞菌定植、第一秒用力呼气容积（FEV）、肺动脉高压、体重指数（BMI）、胰腺功能不全和 CF 相关糖尿病（CFRD）不是死亡率的预测因素。
结论
BCC 与 LTx 后较高的死亡率相关，而 FEV、肺动脉高压、BMI、CFRD 和女性性别与 LTx 后死亡率无关。这些发现表明，CF 特有的 LTx 后死亡率风险估计应该被考虑。
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