초록접수 현황
| 15F-135 | 구연 발표 |
Clinical Outcome of Lung Transplantation from Extended Criteria Donor Lungs
정희석, 이진구, 도영우, 남경식, 이창영, 함석진, 백효채
연세대학교 의과대학 세브란스병원 흉부외과학교실
Background : The number of lung transplantations (LTx) has increased rapidly over the last decades. Accordingly the demand for organs has increased even more, this disparity between the availability of organs and waitlisted patients for transplants has leaded the organ shortage more severe. The aim of this study is to evaluate retrospectively the results of LTx from extended criteria donors in comparison to ideal donor lungs.
Methods : We retrospectively reviewed the medical records and postoperative outcomes of 100 consecutive patients who underwent LTx at our institution. Criteria for donor lungs were considered extended if one or more of the following criteria were satisfied: age ≥ 55 years, PaO2/FiO2 < 300mmHg before harvesting, and history of smoking > 20 pack-years. Seventy-three patients (Group I) received organs from “standard criteria donor (SCD)” and 27 patients (Group II) from “extended criteria donor (ECD)”.
Results : Median donor age of ECD was significantly higher than that of SCD (43 years, interquartile range (IQR) of 30.5 to 46 vs 51 years, IQR of 42 to 55 years, P < 0.001) with lower PaO2/FiO2 ratio (474.1 mmHg, IQR of 417.5 to 521.4 vs 437.5 mmHg, 318.4 to 466.0, P = 0.001), higher incidence of smoking history (0 pack-year, IQR of 0 to 6.25 vs 20 pack-years, IQR of 0 to 30, P < 0.001). Other pre-transplant parameters were comparable. Immediate postoperative ECMO support was more frequent in Group II than Group I (28.8% vs 59.3%, P = 0.006), but no significant differences in duration of mechanical ventilation, intensive care and hospital length of stay, 30 day mortality, and acute and chronic rejection. 6 months, 1-year, 2-year survival (Group I vs II) were also comparable (67.6% vs 55.0%, 61.2% vs 55.0%, 61.2% vs 48.9%, log rank P = 0.531).
Conclusion : Our results suggest that the use of extended donor lungs does not compromise the early and long-term outcomes after LTx. Careful selection of donor lungs from outside the standard acceptability criteria may expand existing donor pool.
Methods : We retrospectively reviewed the medical records and postoperative outcomes of 100 consecutive patients who underwent LTx at our institution. Criteria for donor lungs were considered extended if one or more of the following criteria were satisfied: age ≥ 55 years, PaO2/FiO2 < 300mmHg before harvesting, and history of smoking > 20 pack-years. Seventy-three patients (Group I) received organs from “standard criteria donor (SCD)” and 27 patients (Group II) from “extended criteria donor (ECD)”.
Results : Median donor age of ECD was significantly higher than that of SCD (43 years, interquartile range (IQR) of 30.5 to 46 vs 51 years, IQR of 42 to 55 years, P < 0.001) with lower PaO2/FiO2 ratio (474.1 mmHg, IQR of 417.5 to 521.4 vs 437.5 mmHg, 318.4 to 466.0, P = 0.001), higher incidence of smoking history (0 pack-year, IQR of 0 to 6.25 vs 20 pack-years, IQR of 0 to 30, P < 0.001). Other pre-transplant parameters were comparable. Immediate postoperative ECMO support was more frequent in Group II than Group I (28.8% vs 59.3%, P = 0.006), but no significant differences in duration of mechanical ventilation, intensive care and hospital length of stay, 30 day mortality, and acute and chronic rejection. 6 months, 1-year, 2-year survival (Group I vs II) were also comparable (67.6% vs 55.0%, 61.2% vs 55.0%, 61.2% vs 48.9%, log rank P = 0.531).
Conclusion : Our results suggest that the use of extended donor lungs does not compromise the early and long-term outcomes after LTx. Careful selection of donor lungs from outside the standard acceptability criteria may expand existing donor pool.
첨부파일 : table.pdf
책임저자: 백효채
연세대학교 의과대학 세브란스병원 흉부외과학교실
연락처 : 정희석, Tel: 02-2228-2140 , E-mail : hsjung80@yuhs.ac
