Effect of idiopathic pulmonary fibrosis combined with different degrees of pulmonary hypertension on the early prognosis of lung transplantation
10.3760/cma.j.cn112434-20211230-00422
- VernacularTitle:特发性肺纤维化合并不同程度肺动脉高压对肺移植早期预后的影响
- Author:
Chunlan HU
1
;
Minqiang LIU
;
Jing WANG
;
Huizhi YU
;
Sijia GU
;
Zhong QIN
;
Xiaoshan LI
;
Jingyu CHEN
;
Chunxiao HU
Author Information
1. 南京医科大学附属无锡人民医院麻醉科，无锡 214023
- Keywords:
Idiopathic pulmonary fibrosis;
Lung transplantation;
Plmonary arterial hypertension
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2022;38(11):646-654
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the early prognosis on patient of idiopathic pulmonary fibrosis (IPF) combined with different degrees of pulmonary arterial hypertension (PAH) undertake lung transplantation (LTx).Methods:From January 2017 to December 2020, the clinical data of 134 patients with IPF who underwent LTx in Wuxi People's Hospital were analyzed retrospectively. According to the average pulmonary artery pressure detected by right cardiac catheter before operation, the patients were divided into mild PAH group (63 cases), moderate PAH group (47 cases) and severe PAH group (24 cases). The donor data and the recipient's preoperative, intraoperative and postoperative data were collected; the postoperative survival curve to analyze early survival among the three patient groups.Results:With the increase of pulmonary artery pressure, the rate of abnormal right ventricular function increased, the end diastolic diameter of left ventricle decreased before operation, and the rate of using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) increased during the surgery ( P<0.05). Multivariate analysis found that combined severe PAH had significant effects on primary graft dysfunction (Primary graft dysfunction, PGD), retracheal intubation or tracheotomy, hypovolemic shock within 72 h, and 6-month survival after LTx. The survival surve showed that 30-day survival rates of patients with IPF complicated with mild, moderate and severe PAH were 85.7%, 80.8% and 66.7% respectively, and the 6-month survival rates were 80.9%, 74.0% and 62.2%, respectively. Conclusion:Patient of IPF combined with different degrees of PAH had a significant impact on cardiac function and intraoperative ECMO selection of LTx, and severe PAH could significantly reduce the early survival rate after LTx.
