本期胸小星将为大家带来高风险受者体外肺灌注后的肺移植:全国数据库倾向匹配分析；肺移植后原发性移植肺失功的供体和受体因素：一项DMG分析，一起来看看吧！
2017·EATTS
01
Lung Transplantation After Ex Vivo Lung Perfusion in High-Risk Recipients: A Propensity Matched Analysis of a National Database
Ernest G. Chan1, Rachel L. Deitz2, Jack K. Donohue2, John P. Ryan2, Yota Suzuki2, Masashi Furukawa2, Kentaro Noda2, Pablo G. Sanchez1
1 Department of Surgery, Section of Thoracic Surgery, University of Chicago Medicine, Chicago, IL.
2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Purpose:
We report outcomes associated with EVLP lungs in high-risk lung transplant recipients utilizing a national database.
Methods:
We performed a retrospective analysis of the UNOS Database (1/1/2018-3/31/2024). High-risk status was defined as mean pulmonary arterial pressure >35 mmHg, lung retransplantation, or bridge to transplant. In addition to univariable analysis, propensity score matched analysis was performed on predictors of donor and recipient characteristics.
Results:
Risk of dying on the waitlist was significantly higher for high-risk candidates (HR: 1.69[1.51-1.89], P<0.001). Following matching, 203 EVLP cases were matched to 609 standard procurement recipients. The EVLP group was associated with higher rates of postoperative acute kidney injury requiring renal replacement therapy (27% vs 16%, P< 0.001), higher mortality on index admission (13% vs. 8%, P = 0.04), and longer length of stay (29 vs 25 days, P = 0.006). EVLP modality was associated with survival time (P< 0.001) with portable EVLP having significantly shorter survival (2.7 years) relative to standard cases (4.7 years, P<0.02). A subgroup analysis found that this survival effect was limited to bridge and retransplant recipients.
Conclusions:
EVLP lungs were associated with higher rates of postoperative AKI and portable EVLP was associated with shorter survival in high-risk lung transplant recipients. However, given the high waitlist mortality in this candidate population, EVLP lungs should still be considered an alternative.
[CITATION]: Chan EG, Deitz RL, Donohue JK, et al. Lung Transplantation After Ex Vivo Lung Perfusion in High-Risk Recipients: A Propensity Matched Analysis of a National Database, J Thorac Cardiovasc Surg, 2024 Nov 1.
[DOI]: 10.1016/j.jtcvs.2024.10.041.
[IF]:4.9
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胸“星”外科学术团队成员 刘静 译
目的
方法
结果
结论
Table S1. Post-Transplant Outcomes Across EVLP Modality.
Figure 1: Based on the non-propensity matched analysis, the EVLP group was found to have a significantly lower survival time when compared to standard donation recipients (3.71 vs 5.05 years, P < 0.001). (CI 95%).
2017·EATTS
02
Donor and Recipient Factors Associated with Primary Graft Dysfunction Following Lung Transplantation: A DMG Registry Analysis
Isaac S Alderete1, Cathlyn K Medina2, Arya Pontula3, Samantha E Halpern4, Alexandria L Soto2, Kunal J Patel5, Jacob A Klapper5, Matthew G Hartwig5
1 Duke University School of Medicine, Durham, North Carolina.
2 Duke University School of Medicine, Durham, North Carolina.
3 University of Manchester Medical School, Manchester, UK.
4 Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
5 Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University.
Objectives:
Current risk-adjusted models to predict primary graft dysfunction (PGD) following lung transplantation (LTx) do not include bedside donor critical care data. Donor management goals (DMG) represent predefined critical care endpoints aimed at optimizing multi-organ donor management. Here, we sought to identify novel predictors to better understand the relationship between donor management and PGD following LTx.
Methods:
We used the national DMG registry to identify a cohort of LTx recipients linked to their respective donors between January 1st, 2015 and March 1st, 2023. Grade 3 PGD (PGD3) was defined according to modified ISHLT criteria. Multivariable modeling was performed to identify risk factors for the development of PGD3.
Results:
A total of 2704 eligible patients were identified of which 643 (23.8%) developed PGD3. After multivariable modeling, the likelihood of PGD3 was greater with increased donor age (OR 1.06 [1.02, 1.10] per 5 year change, P = 0.003), increased donor serum pH at the time of authorization (OR 1.14 [1.02, 1.25] per 0.1 increase, P = 0.016), donor history of cocaine use (OR 1.34 [1.05, 1.71], P = 0.020), and increased recipient central venous pressure (1.03 [1.01, 1.06], P = 0.005). Recipients who received donor lungs in which the DMG for PF ratio was met had a lower likelihood of developing PGD3 (OR 0.63 [0.46, 0.86], P = 0.006).
Conclusions:
This study leverages a novel detailed donor management database to identify factors associated with the development of PGD3. These factors may be used to recognize donors and recipients that may benefit from early interventions to improve short-term outcomes.
[CITATION]: Alderete IS, Medina CK, Pontula A, et al Donor and Recipient Factors Associated with Primary Graft Dysfunction Following Lung Transplantation: A DMG Registry Analysis. J Thorac Cardiovasc Surg. 2024 Nov 1:S0022-5223(24)01000-6.
[DOI]: 10.1016/j.jtcvs.2024.10.045.
[IF]: 4.9
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胸“星”外科学术团队成员 刘宋杰 译
目的
方法
结果
结论
Figure 3. Forest Plot of Multivariable Modeling of Independent Predictors of PGD3 development.
Table 3. Univariable Modeling of Continuous DMG variables and Ventilator Parameters associated with PGD3 at Multiple Time Points.
2017·EATTS
