二次性肺高血压诊断在肺部分配中没有用处
Mark A Sonnick1, Kemarut Laothamatas1, David Furfaro2
1Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA.
肺移植候选人的二次肺高血压 (SPH) 诊断太多样化,以至于没有用处. 在ILD中列出患有间歇性肺病和PH的患者,与SPH相比,增加了移植的可能性.
科学领域:
- 肺高血压研究 肺高血压研究
- 肺部移植 肺部移植
- 器官分配系统是指器官分配系统.
背景情况:
- 美国器官共享网络 (UNOS) 在肺移植候选人中使用二次肺高血压 (SPH) 诊断.
- 肺高血压和肺动脉高血压 (PAH) 具有相似的治疗方法和分配分数.
- 在器官分配中使用SPH而不是初级诊断的临床实用性仍然不清楚.
研究的目的:
- 评估SPH诊断对肺移植等候名单和移植后结果的影响.
- 为了比较SPH中列出的患者的结果与COPD中列出的患者的结果,包括PH (COPD-PH),间歇性肺病与PH (ILD-PH) 或初级肺高血压 (PPH).
主要方法:
- 对2005年5月至2021年7月的UNOS数据进行分析.
- 对等候名单死亡率和移植后生存率的竞争风险分析.
- 与COPD-PH,ILD-PH和PPH组相比,SPH诊断的比较.
- 对SPH患者的UNOS螺旋计数据的探索性分析.
主要成果:
- 与在SPH (aHR: 1.34) 下列患者相比,患有ILD-PH的患者更有可能接受移植.
- 在SPH和PPH或COPD-PH组之间没有观察到移植率的显著差异.
- 等候名单死亡率在各组之间没有显著差异.
- 移植后的存活率在PPH患者中较低 (aHR:1.35),但与COPD-PH或ILD-PH相比,在SPH中没有显著差异.
- 螺旋测量数据没有在SPH诊断中显示出明显的临床表型.
结论:
- SPH诊断在临床上是异质的,在UNOS分配模型中缺乏预测效用.
- 在ILD中列出患有晚期肺病和二次PH的患者,与SPH诊断相比,增加了移植概率.
- 应该考虑从UNOS中删除SPH诊断,以提高器官分配的准确性.
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