供肺冷缺血时间对肺移植预后影响的临床观察  

Effect of prolonged cold ischemia time on outcomes after lung transplantation

作　　者：李玉萍[1] 戴洁[1] 刘小刚[1] 何文新[1] 陈昶[1] 朱余明[1] 姜格宁[1] Li Yuping;Dai Jie;Liu Xiaogang;He Wenxin;Chen Chang;Zhu Yuming;Jiang Gening(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University School of Medicine,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院胸外科,上海200433

出　　处：《中华器官移植杂志》2022年第9期530-535,共6页Chinese Journal of Organ Transplantation

基　　金：上海市自然科学基金 (21ZR1453500)。

摘　　要：目的探讨供肺冷缺血时间(CIT)延长对肺移植预后的影响。方法对2019年1月至2022年1月在同济大学附属上海市肺科医院接受肺移植的111例供受者资料进行回顾性分析。根据供肺CIT分为CIT延长组(CIT 8~12 h,41例)和对照组(CIT<8 h,70例),比较两组供受者最后一次血气分析、冷缺血时间等临床资料、术后并发症及短期生存情况的差异。绘制生存曲线,采用Kaplan-Meier法估计两组累积存活率。采用Cox比例风险回归分析明确受者1年死亡率的独立危险因素。结果共计纳入111例肺移植受者,CIT延长组和对照组分别为41例(36.9%)和70例(63.1%)。两组受者术后72 h内原发性移植物功能不全(PGD)3级的发生率分别为21.2%和16.3%,两组术后的30 d存活率分别为90.2%和94.3%,90 d存活率分别为82.9%和82.9%,两组比较差异均无统计学意义(均P>0.05)。两组受者1年的累积存活率分别为74.6%比60.4%,差异无统计学意义(P=0.279)。Cox回归分析显示CIT延长供肺移植与受者1年死亡风险增加无关(HR 0.691,95%CI:0.317~1.506),但术中未使用体外膜氧合(ECMO)技术(HR 3.562,95%CI:1.061~11.959)以及术后机械通气超过3 d(HR 2.892,95%CI:1.387~6.031)会增加受者1年的死亡风险。结论供肺CIT延长至8~12 h进行肺移植对受者预后未产生不良影响。在权衡受者继续等待和接受移植两者的死亡风险后,接受CIT 8~12 h的供肺是可行的。Objective To evaluate the effect of prolonged graft cold ischemia time(CIT)on outcomes of lung transplantation(LTx).Methods Clinical data are retrospectively reviewed for 111 patients undergoing LTx at Affiliated Shanghai Pulmonary Hospital of Tongji University between January 2019 and January 2022.They are divided into two groups of prolonged CIT(8~12 h,41 cases)and control(<8 h,70 cases)according to CIT.Kaplan-Meier method is employed for estimating 1-year cumulative survival rate and multivariable Cox proportional hazard regression model for identifying independent risk factors of 1-year mortality.Results No significant inter-group difference existed in the incidence of primary graft dysfunction gradeⅢwithin the first 72 h post-LTx(21.2%vs.16.3%).The 30-day(90.2%vs.94.3%)and 90-day(82.9%vs.82.9%)survival rates are comparable between two groups.Similarly 1-year cumulative survival is also comparable between two groups(74.6%vs.60.4%,Log-rank P=0.279).Multivariate Cox regression analysis indicated that prolonged CIT was not associated with an elevated risk of 1-year mortality(HR 0.691;95%CI:0.317~1.506).However,an absence of ECMO support during surgery(HR 3.562;95%CI:1.061~11.959)and postoperative mechanical ventilation for>3 days(HR 2.892;95%CI:1.387~6.031)elevate 1-year risk of mortality.Conclusions Prolongation of CIT to 8~12 h has no adverse effect on the prognosis of recipients.Given a great scarcity of donor lungs and a growing number of LTx candidates,it is reasonable to accept prolonged CIT donor lungs for clinical LTx.

关 键 词：肺移植 冷缺血时间 存活率 

分 类 号：R655.3[医药卫生—外科学]