ABSTRACT
Objective To study the influence of pulmonary artery hypertension (PAH) on survival of patients with advanced chronic obstructive pulmonary disease (COPD) on the waiting list of lung transplantation.Methods The characteristics of 143 patients with COPD receiving lung transplantation evaluation from January 2014 to August 2016 were queried.Mild PAH was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg and severe ≥35 mrnHg by right heart catheterization measurements.The incidence of PAH was studied,and the patients were divided to different groups to determine the effect of PAH on survival prior to transplantation on the basis of different definitions of PAH.Kaplan Meier method was used to draw survival curves,and a log-rank test was used to analyze the effect of PAH on survival of COPD patients on the waiting list of pulmonary transplantation.Univariate and multivariate Cox proportional hazard models were performed to test the relationship between each main covariate and the hazard of mortality.The waiting time was tracked from wait list entry date until death or censoring,and the censoring issues were as follows:receiving lung transplantation,removing from the waiting list without transplant,and still wating for donor until the last follow-up day (2016-08-30).Results Of 143 COPD patients,there were 119 males and 24 males,with mean age of 61.73 years old;46 patients received lung transplantation,and the remaining 97 not;50 had mPAP ≥25 mmHg and 21 had mPAP ≥35 mmHg.A total of 23 cases (22.88％) died on the waiting list.Thirty-eight patients were removed from the list prior to transplantation,and 36 were still on the waiting list.Kaplan-Meier survival function showed suvival of patients with mild PAH or severe PAH was significantly shorter than that of patients without PAH (P＜0.001).Using Cox proportional hazards models,univariate analysis revealed significant differences in survival for mild PAH (HR =2.147,95％CI 1.429-3.157,P＜ 0.001) and severe PAH (HR =3.458,95 ％ CI 2.518-4.859,P＜0.001).Multivariate Cox models identified significant risk for death for mild PAH (HR=2.518,95％CI 1.728-3.364,P＜0.001) and severePAH HR=4.027,95％ CI 3.257-4.703,P＜0.001).Conclusion The incidence of PAH among COPD patients waiting for lung transplantation was high.PAH is associated with significantly increased risk of death among COPD patients waiting for lung transplantation.
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Objective To summarize the lung transplant program using donation after death of citizens (DCD).Methods Retrospective characteristics of 242 patients with end-stage lung diseases receiving lung transplantation in our hospital were reviewed between January 2015 and December 2016.The data about evaluation and collection of all donors were analyzed.The survival rate,causes of deaths,and postoperative complications were reviewed.Kaplan Meier survival curves and a logrank test of differences in survival functions were used to assess the effect of lung transplant type and extracorporeal membrane oxygenation (ECMO) on survival post transplant.Results A total of 231 patients donated their lungs,including China type three (135 cases),China type two (19 cases),and China type one (77 cases).242 lung transplantations were successfully performed.The 3-month,6-month and 1-year survival rate after lung transplantation was 80.6％,80.6％,and 77.8％,respectively.There were 47 deaths during perioperative period,including 22 cases of primary graft dysfunction,14 cases of sepsis,6 cases of multiple organ failure,3 cases of heart failure,and 2 cases of stomal leak.One hundred and thirty-two patients received bilateral lung transplantation,with 3-month,6-month,and 1-year survival rate being 78.6％,78.6％,and 75.6％ respectively.110 underwent single lung transplantation with 3-month,6-month,and 1-year survival rate being 82.7 ％,82.7 ％,and 80.1％,respectively.No significant difference in survival rate was observed between single and bilateral lung transplantation (P＞0.05).One hundred and twenty-nine cases of lung transplants were conducted under ECMO support,with the 3-month,6-month and 1-year survival rate being 72.5％,72.5％,and 70.5％ respectively,which was significantly higher in those without ECMO with the 3-month,6-month and 1-year survival rate being 90.2％,90.2％ and 86.6％ respectively (n =113) (P ＜ 0.05).Conclusion DCD may facilitate the development of lung transplantation in China with long-term survival.
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Objective To evaluate the effects of ambroxol on prevention of bronchopulmonary complications after thoracotomy in patients with chronic obstructive pulmonary disease(COPD).MethodsTotal 161 elderly patients aged ≥70 years with COPD undergoing thoracotomy were randomly allocated to two groups:ambroxol group (300 mg/d,6 d) and placebo group as control.Pulmonary complications were evaluated by clinical symptoms,radiographic changes,and blood gas analysis. Results The incidence rates of atelectasis were 8.6％ in ambroxol group and 28.8％ in placebo group,respectively.The PaO2 values after surgery in ambroxol group decreased more than in placebo group (P＜0.05) compared with the preoperative values.Side effects were not found in all patients.Conclusions Ambroxol should be considered as an alternative pharmacologic approach for the prevention of post-thoracotomy pulmonary complications in the elderly patients with COPD.
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Objective To summarize the clinical experience of harvesting and using the lungs of cardiac death donor.Methods The lungs from donation after cardiac death (DCD) were harvested and used for lung transplantation.The donors suffered from severe craniocerebral trauma or brain neoplasms and were identified after cardiac death post declaration of brain death.Written consent about DCD was obtained from the consanguinities.The donor lungs were harvested after clinical evaluation of donors with considerable function and after the determination of DCD.The preoperative lymphocytotoxic cross match test was negative,ABO blood type was compatible,and the donors were all suitable for the transplant procedure.Results Two bilateral lung transplantations and one single lung transplantation were performed,with the warm ischemic time being 23,27,and 32 min,respectively.The operative course was uneventful The ICU stay was 31,18,and 26 days respectively,with dramatic improvement of pulmonary function postoperatively.Acute rejection occurred in two cases,which was treated with bolus of corticoids.There were no infection in our 3 patients,and the life quality was satisfactory during the follow-up period.Conclusion The lung from DCD may be one of the available resources used for lung transplantation on the basis of efficient management of the potential donors and clear evaluation of the donors.