Lobar Lung Transplantation - Is It Comparable to Standard Lung Transplantation?

详细信息    查看全文

• 作者：A. Slama ; A. Hoda ; T. Klikovits ; A. Scheed ; K. Hö ; tzenecker ; J. Matilla ; G. Lang ; S. Taghavi ; W. Klepetko ; C. Aigner
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：32
• 期：4_supp_S
• 页码：S267
• 全文大小：120 K

文摘

Purpose

Lobar lung transplantation (LLT) is a therapeutic option mainly for urgent small recipients. Only series with limited numbers have been reported. This approach is technically more demanding than standard LuTX or simple downsizing by wedge resections. In our center this approach was liberally applied and we report the largest series of deceased donor LLT so far.

Methods and Materials

We performed an analysis of our prospective lung transplant database from 1/2001 to 10/2012 and compared the clinical outcome of LLT recipients to those receiving standard donor organs or downsizing by simple peripheral wedge resection.

Results

779 LuTX (group 1) were performed either in standard technique (n=542) or with downsizing by wedge resections (n=237). 132 LuTXwere performed in lobar technique (group 2). In group 2 there were significantly more females (57,6 % vs. 45,4 % ; p=0,011). Patients in group 2 were significantly younger (median 36,5 vs. 51,6 years, p<0,014), had a different spectrum of diagnoses (CF: 34,8 % vs. 17,9 % ; Fibrosis: 34,1 % vs. 19,0 % ; COPD: 11,4 % vs. 39,9 % ; p<0,001), were more frequently ventilated prior to tx (7,6 % vs. 3,6 % ; p<0,001) and required more often extracorporeal support as bridging (12,5 % vs. 2,9 % ; p<0,001). Intubation time was longer in group 2 (median 5,5 vs.1 day; p<0,001) as well as ICU stay (median: 17 vs.6 days; p=0,027) and hospital stay (median: 38,5 vs.23 days; p=0,006. BOS rate was significantly lower in group 2 (10,6 % vs.21,5 % ;p<0,001). In hospital mortality was higher in group 2 (18,9 % vs.7,8 % ; p<0,005). 1 year survival was 65,2 % vs.83,8 % ; 3 years survival 61,5 % vs.75,8 % and 5 years survival 54,6 % vs.66,4 % (p<0,001).

Conclusions

Patients receiving LLT represent a different patient group than those receiving standard LuTX. The observed outcome is in contrast to previous publications inferior to standard LuTX recipients, which is explained by the different indication spectrum and a higher rate of patients invasively bridged to transplantation. Nevertheless LLT remains a valid and important option in the management of urgent small recipients.