肺移植中的预后因素是与移植结果相关的变量。对供体和受体预后变量的了解可以帮助将供体肺最佳分配给移植受体,并且还可以告知患者关于预后的术后讨论。目前与肺移植预后因素相关的研究结果不一致,各种因素的相对重要性尚不清楚。这篇综述旨在为成人肺移植受者的推定预后变量与1年全因死亡率之间的关系提供最佳估计。
我们搜索了5个书目数据库,用于评估推定预测因子(与肺供体相关,收件人,或移植手术)和1年受体死亡率。我们在证明合理的情况下汇总了研究数据,并利用GRADE方法来评估证据的确定性。
来自72项符合条件的研究(2002-2020年),有34个接收者变量,4个供体变量,10个程序变量,和7个移植后并发症变量适用于荟萃分析。证据具有高度的确定性,仅移植后需要体外膜氧合(ECMO)(HR1.91,95%CI1.79-2.04)预测1年死亡率。没有供体变量似乎可以预测具有高甚至中等确定性的移植结果。
在临床医生接受肺移植的当代供体和受体范围内,这次审查,具有很高的确定性,发现1个预测1年死亡率的预后因素,和37个具有中等确定性的额外因素。对一些广泛接受的因素缺乏预后意义(例如,捐献者吸烟,年龄)可能与捐赠者和接受者选择时这些变量范围的现有限制有关。
Prognostic factors in lung transplantation are those variables that are associated with transplant outcomes. Knowledge of
donor and recipient prognostic variables can aid in the optimal allocation of
donor lungs to transplant recipients and can also inform post-operative discussions with patients about prognosis. Current research findings related to prognostic factors in lung transplantation are inconsistent and the relative importance of various factors is unclear. This
review aims to provide the best possible estimates of the association between putative prognostic variables and 1-year all-cause mortality in adult lung transplant recipients.
We searched 5 bibliographic databases for studies assessing the associations between putative predictors (related to lung donors, recipients, or the transplant procedure) and 1-year recipient mortality. We pooled data across studies when justified and utilized GRADE methodology to assess the certainty in the evidence.
From 72 eligible studies (2002-2020), there were 34 recipient variables, 4 donor variables, 10 procedural variables, and 7 post-transplant complication variables that were amenable to a meta-analysis. With a high degree of certainty in the evidence only post-transplant need for extra-corporeal membrane oxygenation (ECMO) (HR 1.91, 95% CI 1.79-2.04) predicted 1-year mortality. No
donor variables appeared to predict transplant outcome with high or even moderate certainty.
Across the range of contemporary donors and recipients that clinicians accept for lung transplantation, this
review, with high certainty, found 1 prognostic factor that predicted 1-year mortality, and 37 additional factors with a moderate degree of certainty. The lack of prognostic significance for some widely accepted factors (e.g.,
donor smoking, age) likely relates to existing limits in the range of these variables at the time of donor and recipient selection.