脑死亡供者肺移植近期预后分析

Short-term outcomes of lung transplant recipients using organs from brain death donors

目的：探讨脑死亡供者（ DBD）肺移植近期预后情况。方法回顾性分析2015年4月至2016年7月在同济大学附属上海市肺科医院胸外科接受DBD肺移植的17例受者的临床资料。受者均为男性，年龄（60±7）岁，原发病包括慢性阻塞性肺疾病11例，特发性肺纤维化5例，矽肺1例。16例接受单肺移植。分析肺移植受者术后肺部感染、支气管吻合口并发症、原发性移植物功能障碍、急性排斥反应和闭塞性细支气管炎综合征的发生率，以及术后90 d的病死率，评估DBD肺移植的近期预后。结果受者术后气管插管时间为2（2）d[M（QR）]，术后住院时间为56（19）d。气管切开5例，发生肺部细菌感染15例，发生支气管吻合口并发症5例。10例患者出院后1个月内再次入院，1例患者发生3级原发性移植肺功能障碍。2例患者于术后90 d内死亡，2例患者发生闭塞性细支气管炎综合征。结论 DBD肺移植受者近期生存率尚可，但早期感染相关并发症发生率较高。

Objective To assess short？term outcomes after lung transplantation with organs procured following brain death？Methods Between April 2015 and July 2016, all 17 recipients after lung transplantation using organs from brain death donors （ DBD） at Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine were enrolled in this study？ All patients were male, aging （60±7） years, including 11 chronic obstructive pulmonary disease, 5 idiopathic pulmonary fibrosis, 1 silicosis. Seventeen donors were 16 males and 1 female, with 10 traumatic brain injury, 5 cerebrovascular accident and 2 sudden cardiac death？ Of 17 recipients receiving DBD lung transplant, 16 were single lung transplant？ Data were collected including intubation duration of mechanical ventilation, hospital length of stay, incidence of pulmonary infection bronchus anastomosis complications, primary graft dysfunction （PGD）, and acute rejection, bronchiolitis obliterans syndrome （BOS） as well as mortality of 90？day after lung transplantation？ Results Median duration of intubation were 2 （2） days （M（QR）） in recipients after lung transplantation？ The incidence of pulmonary infection and bronchus anastomosis complications were 15/17 and 5/17, respectively？ Median length of stay in hospital were 56 （ 19） days？ The ratio of readmission 1 month after discharge were 10/17？ Mortality of 90？day post？transplant were 2/17？ The incidence of PGD and BOS were 1/17 and 2/17, respectively？Conclusion Recipients with DBD lung transplantation have an acceptable survival during short？term follow？up, but with higher incidences of complications related to infection post？transplantation.