活体肺 perfusion:国家趋势和移植后的结果
Jonathan E Williams1, Sara L Schaefer1, Ryan C Jacobs2
1Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
概括
活体肺输液 (ex-vivo lung perfusion,简称EVLP) 没有增加肺移植体积,接受者有更糟糕的结果,包括更高的30天死亡率和更长的住院时间. 需要进一步的研究来优化EVLP的使用.
科学领域:
- 移植研究 移植研究
- 胸部外科手术 胸部外科手术
- 器官采购和器官移植
背景情况:
- 活体肺输液 (ex-vivo lung perfusion,简称EVLP) 显示出增加供体肺利用率和提高移植活性的前景.
- 对于EVLP的采用及其对接受者结果的影响的国家趋势在很大程度上仍然没有特征.
研究的目的:
- 分析美国用于肺移植的EVLP利用的国家趋势.
- 评估EVLP使用与接受者结果之间的关联,包括死亡率,移植功能障碍和资源利用.
主要方法:
- 从OPTN数据库 (2013-2023) 中对成年肺移植接受者的分析.
- 差异分析评估了EVLP对中心体积的影响.
- 多变量后勤回归评估了EVLP与30天死亡率,PGD,通风和停留时间之间的关联.
主要成果:
- 在23,807例肺移植中,813例 (3.4%) 使用了EVLP.
- 使用EVLP与整体移植量增加没有相关性.
- 接受EVLP治疗的患者的30天死亡率较高 (3.8%与2.4%相比),72小时后增加机械呼吸的需要 (40.2%与31.2%相比),以及术后停留时间较长 (35.8与30.0天).
- 在3级初级移植功能障碍 (PGD) 中没有发现显著差异.
结论:
- 美国肺移植量增加目前不能归因于EVLP的采用.
- 这项研究揭示了EVLP和非EVLP肺移植接受者之间的显著结果差异.
- 对患者选择标准和机构实践的进一步调查对于优化EVLP结果至关重要.
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