再次肺移植治疗肺移植术后闭塞性细支气管炎综合征

Lung retransplantation for bronchiolitis obliterans syndrome after primary lung transplantation

目的探讨再次肺移植治疗肺移植术后闭塞性细支气管炎综合征(BOS)的疗效。方法回顾性分析无锡市人民医院胸外科7例因肺移植术后BOS行再次肺移植的受者临床资料。其中男性5例,女性2例,中位年龄45岁(29~70岁),原发病包括间质性肺炎2例、慢性阻塞性肺疾病2例、支气管扩张1例、原发性肺动脉高压1例、骨髓移植术后慢性闭塞性细支气管炎1例。首次肺移植术后7例患者均出现肺功能进行性下降,最终诊断为BOS。再次肺移植术式为5例单肺移植和2例序贯式双肺移植,其中1例双肺移植和1例单肺移植在体外膜肺氧合辅助下完成。结果 1例受者术中出血2 000 m L,术后第2天出现急性肺水肿,于术后第8天因重症肺部感染死亡。1例受者术中出现心跳骤停,于术后第4天因多器官功能衰竭死亡。其余5例受者手术过程顺利,术后恢复良好,均在术后1个月内出院。截至2017年7月,随访半年以上的4例受者肺功能检测示一秒用力呼气容积分别为2.0、1.8、1.8、2.5 L,分别占术后基线值92.3%、91.1%、89.1%、92.1%,生活质量明显改善,日常活动不受限。结论再次肺移植是治疗肺移植术后BOS的有效方法,但受者选择标准、手术方式、影响术后生存的危险因素等关键问题仍需进一步研究。

Objective To investigate the outcome of lung retransplantation for recipients with bronchiolitis obliterans syndrome（ BOS） after primary lung transplantation. Methods Lung retransplantations were performed for 7 recipients with BOS after primary transplantation in Wuxi People＇s Hospital. The primary diseases were diagnosed with end-stage pulmonary diseases,in which there were 2 interstitial pneumonia,1 bronchiectasis,1 pulmonary hypertension,1 BOS following hematopoietic cell transplantation and 2 chronic obstructive pulmonary disease. These recipients with gradual decline in pulmonary function after first lung transplant received lung retransplantations for BOS. Two recipients received bilateral sequence lung transplantation and one of which was under extracorporeal membrane oxygenation support. Five recipients received single lung transplantation and one of which was under extracorporeal membrane oxygenation support. Results The course of operations were smooth. Case 1 died of infection on postoperative day 8 and case 2 died of multiple organ failure resulting from post-resuscitation syndrome on the fourth day after operation. The remaining 5 recipients recoved well during the follow-up until July 2017 and the pulmonary function was improved significantly. Conclusion Lung retransplantation is an important therapeutic strategy in treating BOS following initial transplant and more important issues like selection criteria of recipient,surgical method and risk factors for postoperation survival still need further research.