目的:肺移植(LT)治疗肺纤维化的死亡率高于其他移植适应症。我们的目的是评估前纵隔脂肪(AMF)的量是否与接受LT的纤维化患者的早期和长期预后相关。
方法:回顾性分析92例肺纤维化的连续单肺移植(SLT)10年。在术前CT扫描上测量AMF尺寸:前后轴(AP),横轴(T),高度(H)。AMF体积(V)按下式计算:AP×T×H×3.14/6。根据放射性AMF尺寸,患者分为低AMF(V<20cm3)和高AMF(V>20cm3)两组,通过单变量和多变量分析比较早期和长期结局.
结果:有92SLT:73M/19F,53±11[14-68]岁。30天死亡率(低AMF与高AMF):5(5.4%)与15(16.3%),p=0.014。患者在移植后72小时内出现原发性移植物功能障碍,那些在移植后30天内死亡的人表现出更高的AMF体积:21.1±19.843.3±24.7cm3(p=0.03)和24.4±24.2vs.56.9±63.6cm3(p<0.01)。总生存率(低AMF与高AMF)(1、3和5年):85%,81%,78%vs.55%,40%,33%(p<0.001)。预测30天死亡率的因素是:BMI(HR=0.77,p=0.011),AMF体积(HR=1.04,p=0.018),CPB(HR=1.42,p=0.002),缺血时间(HR=1.01,p=0.009)。预测生存的因素是:AMF体积(HR=1.02,p<0.001),CPB(HR=3.17,p=0.003),缺血时间(HR=1.01,p=0.001)。
结论:术前纵隔脂肪尺寸和体积的放射学评估可能是确定单肺移植后死亡风险较高的纤维化患者的有用工具。
OBJECTIVE: Lung transplantation (LT) for pulmonary fibrosis is related to higher mortality than other transplant indications. We aim to assess whether the amount of anterior mediastinal fat (AMF) was associated to early and long-term outcomes in fibrotic patients undergoing LT.
METHODS: Retrospective analysis of 92 consecutive single lung transplants (SLT) for pulmonary fibrosis over a 10-year period. AMF dimensions were measured on preoperative CT-scan: anteroposterior axis (AP), transverse axis (T), and height (H). AMF volumes (V) were calculated by the formula: AP×T×H×3.14/6. According to the radiological AMF dimensions, patients were distributed into two groups: low-AMF (V<20cm3) and high-AMF (V>20cm3), and early and long-term outcomes were compared by univariable and multivariable analyses.
RESULTS: There were 92 SLT: 73M/19F, 53±11 [14-68] years old. 30-Day mortality (low-AMF vs. high-AMF): 5 (5.4%) vs. 15 (16.3%), p=0.014. Patients developing primary graft dysfunction within 72h post-transplant, and those dying within 30 days post-transplant presented higher AMF volumes: 21.1±19.8 vs. 43.3±24.7cm3 (p=0.03) and 24.4±24.2 vs. 56.9±63.6cm3 (p<0.01) respectively. Overall survival (low-AMF vs. high-AMF) (1, 3, and 5 years): 85%, 81%, 78% vs. 55%, 40%, 33% (p<0.001). Factors predicting 30-day mortality were: BMI (HR=0.77, p=0.011), AMF volume (HR=1.04, p=0.018), CPB (HR=1.42, p=0.002), ischaemic time (HR=1.01, p=0.009). Factors predicting survival were: AMF volume (HR=1.02, p<0.001), CPB (HR=3.17, p=0.003), ischaemic time (HR=1.01, p=0.001).
CONCLUSIONS: Preoperative radiological assessment of mediastinal fat dimensions and volumes may be a useful tool to identify fibrotic patients at higher risk of mortality after single lung transplantation.