Yun, Jae Kwang
(Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine)
,
Choi, Se Hoon
(Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine)
,
Park, Seung-Il
(Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine)
Background: Heart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center. Methods: Between July 2010 and August 2014, a t...
Background: Heart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center. Methods: Between July 2010 and August 2014, a total of 11 patients underwent HLT at Asan Medical Center. After excluding one patient who underwent concomitant liver transplantation, 10 patients were enrolled in our study. We reviewed the demographics of the donors and the recipients' baseline information, survival rate, cause of death, and postoperative complications. All patients underwent follow-up, with a mean duration of $26.1{\pm}16.7months$. Results: Early death occurred in two patients (20%) due to septic shock. Late death occurred in three patients (38%) due to bronchiolitis obliterans (n=2) and septic shock (n=1), although these patients survived for 22, 28, and 42 months, respectively. The actuarial survival rates at one year, two years, and three years after HLT were 80%, 67%, and 53%, respectively. Conclusion: HLT is a procedure that is rarely performed in Korea, even in medical centers with large heart and lung transplant programs. In order to achieve acceptable clinical outcomes, it is critical to carefully choose the donor and the recipient and to be certain that all aspects of the transplant procedure are planned in advance with the greatest care.
Background: Heart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center. Methods: Between July 2010 and August 2014, a total of 11 patients underwent HLT at Asan Medical Center. After excluding one patient who underwent concomitant liver transplantation, 10 patients were enrolled in our study. We reviewed the demographics of the donors and the recipients' baseline information, survival rate, cause of death, and postoperative complications. All patients underwent follow-up, with a mean duration of $26.1{\pm}16.7months$. Results: Early death occurred in two patients (20%) due to septic shock. Late death occurred in three patients (38%) due to bronchiolitis obliterans (n=2) and septic shock (n=1), although these patients survived for 22, 28, and 42 months, respectively. The actuarial survival rates at one year, two years, and three years after HLT were 80%, 67%, and 53%, respectively. Conclusion: HLT is a procedure that is rarely performed in Korea, even in medical centers with large heart and lung transplant programs. In order to achieve acceptable clinical outcomes, it is critical to carefully choose the donor and the recipient and to be certain that all aspects of the transplant procedure are planned in advance with the greatest care.
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문제 정의
In this study we presents the clinical outcomes of HLTs performed at the Asan Medical Center over a five-year period, with acceptable short- and mid-term survival rates. The survival rates at one year and three years in this study were 80% and 53%, whereas they were 63% and 52% in the (ISHLT) study [2].
However, the survival rate of the Korean HLT recipients has not yet been investigated due to the low number of cases of HLT. Therefore, the purpose of this study was to evaluate the clinical outcomes of HLT at a single medical center over five years.
제안 방법
However, until recently it has been difficult to assess the reversibility of right ventricular function in patients with right heart failure due to the lack of definite criteria. Consequently, the decision to perform HLT was made by experienced cardiologists who had specialized in performing heart transplantation for 20 years in consultation with pulmonologists based on the echocardiogram, cardiac computed tomography, and/or information derived from cardiac catheterization. According to the Asan Medical Center protocol, six patients with end-stage lung disease underwent HLT rather than isolated lung transplantation due to moderate-to-severe right heart failure with pulmonary HTN, although the ejection fraction was sometimes within the normal range.
The patients did not undergo surveillance endomyocardial biopsies, but did have a routine transthoracic echocardiogram once a week until discharge and two, four, six, and 12 months after discharge.
Both pediatric and adult patients were included. The patients were sorted through our prospectively maintained HLT registry database containing clinical information regarding the recipients and donors. Clinical outcomes including deaths and complications following HLT were meticulously reviewed using the patients’ electronic medical records of Asan Medical Center.
The surveillance bronchoscopy was routinely performed at two, four, six, and 12 months and annually thereafter. Either endomyocardial or lung biopsies were obtained only when rejection was suggested clinically.
대상 데이터
The reasons for HLT were interstitial lung disease with rapidly deteriorating pulmonary function (n=3), toxic acute respiratory distress syndrome (n=2), atrial septal defect with pulmonary HTN (n=1), dilated cardiomyopathy with pulmonary HTN (n=1) with a previous heart transplantation, ischemic cardiomyopathy with acute respiratory distress syndrome (n=1), angiosarcoma (n=1), and bronchiectasis (n=1). The mean patient height was 165 cm (range, 109 to 170 cm), and the mean weight was 62 kg (range, 18 to 74 kg). Eight patients (80%) were on preoperative ventilatory support, the median duration of which was 20.
이론/모형
1. Overall survival curves after heart-lung transplantation, using the Kaplan-Meier method.
성능/효과
The survival duration of these patients was 22, 28, and 42 months, respectively. The actuarial survival rates at one, two, and three years after HLT were 80%, 67%, and 53%, respectively (Fig. 1). The common late complications were BOS in two patients (25%), chronic renal failure in two patients (25%), and hematogenous infection in two patients (25%).
Early mortality occurred preoperatively in 17% (1/6) of the ECMO-supported patients and in 25% (1/4) of the unsupported patients. The survival rate of the ECMO-supported patients was 83% over the course of one to three years, whereas the survival rate of the unsupported patients was 75% at one year and 25% at three year, although this was not a statistically significant difference (p=0.495). The MV-supported patients had longer preoperative ICU stays than the unsupported patients (45 days vs.
후속연구
However our study does provide valuable, recent, and detailed morbidity and mortality information regarding post-HLT patients in a Korean cohort. A cumulative analysis of HLT cases and a multicenter study will be required in order to further evaluate the actual survival outcomes and prognosis after HLT in Korean patients.
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