Effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis after lung transplantation
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摘要:
目的 探讨供者年龄对特发性肺纤维化(IPF)患者肺移植术后短期生存结局的影响。 方法 回顾性分析235例IPF肺移植供、受者的临床资料。使用单因素和多因素Cox比例风险回归模型分析供者年龄与IPF患者肺移植术后短期死亡风险的关系,采用Kaplan-Meier法绘制生存曲线。 结果 单因素Cox回归分析结果显示,供者年龄与IPF患者肺移植术后1年病死率相关,供者年龄每增加1岁,受者术后1年死亡风险增加0.020倍(P=0.009)。供者氧合指数,受者术前氧合指数、术前肺源分配评分、术前氨基末端脑钠肽前体、移植方式、术中体外膜氧合方式和术中输血量与肺移植术后1年病死率存在相关性(均为P < 0.1)。多因素Cox回归分析显示,供者年龄与IPF患者肺移植术后30、90、180 d和1年的死亡风险无相关性(均为P > 0.05)。敏感性分析发现供者年龄 < 18岁、18~33岁、34~49岁、≥50岁的肺移植受者术后30、90、180 d和1年死亡风险差异均无统计学意义(均为P > 0.05)。 结论 本研究未观察到供者年龄对IPF患者肺移植术后短期生存存在影响,综合考虑供者机械通气时间、氧合指数、感染等因素后,可考虑扩大肺移植供者年龄范围。 Abstract:Objective To evaluate the effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 235 IPF donors and recipients of lung transplantation were retrospectively analyzed. Univariate and multivariate Cox proportional hazard regression models were employed to analyze the correlation between donor age and short-term mortality rate of IPF patients after lung transplantation. Kaplan-Meier was used to draw the survival curve. Results Univariate Cox regression analysis showed that donor age was correlated with the 1-year fatality of IPF patients after lung transplantation. The 1-year fatality of recipients after lung transplantation was increased by 0.020 times if donor age was increased by 1 year (P=0.009). Oxygenation index of the donors, preoperative oxygenation index, preoperative lung allocation score, preoperative N-terminal pro brain natriuretic peptide, pattern of transplantation, pattern of intraoperative extracorporeal membrane oxygenation and intraoperative blood transfusion volume of the recipients were correlated with 1-year fatality after lung transplantation (all P < 0.1). Multivariate Cox regression analysis demonstrated that there was no correlation between donor age and 30-, 90-, 180-d and 1-year fatality of IPF patients after lung transplantation (all P > 0.05). Sensitivity analysis showed that there was no significant difference in 30-, 90-, 180-d and 1-year fatality after lung transplantation among donors aged < 18, 18-33, 34-49 and ≥50 years (all P > 0.05). Conclusions Donor age exerts no effect upon short-term survival of IPF patients after lung transplantation. Considering the mechanical ventilation time, oxygenation index, infection and other factors of donors, the age range of lung transplant donors may be expanded. -
表 1 IPF患者肺移植术后1年病死率的单因素Cox回归分析
Table 1. Univariate Cox regression analysis of 1 year fatality after lung transplantation in patients with IPF
变量 基本特征(n=235) β值 HR(95% CI) P值 供者资料 性别[n(%)] 女 55(23.4) 0.002 1.002(0.634~1.578) 0.995 男 180(76.6) 参照值 1.000 年龄[M(P25,P75),岁] 40(29, 48) 0.020 1.020(1.005~1.036) 0.009 BMI[M(P25,P75),kg/m2] 23(22, 25) 0.024 1.024(0.961~1.091) 0.461 机械通气时间[M(P25,P75),d] 5(3, 8) -0.002 0.998(0.986~1.010) 0.741 氧合指数[M(P25,P75),mmHg①] 440(370, 498) -0.002 0.998(0.995~1.000) 0.054 冷缺血时间[M(P25,P75),min] 453(375, 545) 0 1.000(0.999~1.002) 0.772 受者资料 性别[n(%)] 女 39(16.6) -0.066 0.936(0.564~1.554) 0.799 男 196(83.4) 参照值 1.000 年龄[M(P25,P75),岁] 61(54, 66) 0.003 1.003(0.985~1.021) 0.737 BMI[M(P25,P75),kg/m2] 22(20, 25) 0.017 1.017(0.970~1.067) 0.475 术前糖尿病史[n(%)] 否 175(74.5) 0.088 1.092(0.698~1.709) 0.700 是 60(25.5) 参照值 1.000 术前高血压病史[n(%)] 否 175(74.5) 0.329 1.309(0.870~2.221) 0.169 是 60(25.5) 参照值 1.000 术前氧合指数[M(P25,P75),mmHg] 267(219, 310) -0.003 0.997(0.994~0.999) 0.010 术前LAS[M(P25,P75),分] 40(36, 53) 0.014 1.014(1.003~1.025) 0.010 术前血清肌酐[M(P25,P75),μmol/L] 58(50, 71) -0.007 0.993(0.980~1.005) 0.254 术前eGFR[M(P25,P75),mL/min] 104(83, 126) 0.002 1.002(0.996~1.009) 0.437 术前肺动脉收缩压[M(P25,P75),mmHg] 41(28, 60) -0.006 1.006(0.996~1.016) 0.215 术前肺动脉平均压[M(P25,P75),mmHg] 31(25, 39) 0.007 1.007(0.989~1.026) 0.443 术前NT-proBNP[M(P25,P75),pg/mL] 129(53, 350) 0 1.000(1.000~1.000) 0.061 手术资料 移植方式[n(%)] 单肺移植 125(53.3) -0.378 0.685(0.465~1.010) 0.056 双肺移植 110(46.7) 参照值 1.000 术中ECMO方式[n(%)] 静脉-静脉 131(55.8) 0.527 1.694(0.934~3.074) 0.083 静脉-动脉 65(27.5) 0.354 1.425(0.738~2.752) 0.291 未使用 39(16.7) 参照值 1.000 手术时间[M(P25,P75),min] 320(240, 400) 0.001 1.001(0.999~1.003) 0.312 术中出血量[M(P25,P75),mL] 1 000(600, 1 200) 0 1.000(1.000~1.000) 0.988 术中输血量[M(P25,P75),mL] 1 025(600, 1 450) 0 1.000(1.000~1.000) 0.002 术中尿量[M(P25,P75),mL/(kg·h)] 5(4, 7) -0.033 0.967(0.909~1.029) 0.293 注:①1 mmHg=0.133 kPa。 表 2 供者年龄与IPF患者肺移植术后死亡风险的多因素Cox回归分析
Table 2. Multivariate Cox regression analysis of donor age and risk of death after lung transplantation in patients with IPF
随访时间(d) β值 HR 95% CI P值 365 0.013 1.013 0.991~1.036 0.237 180 0.020 1.020 0.995~1.046 0.117 90 0.017 1.017 0.991~1.044 0.200 30 0.024 1.024 0.988~1.062 0.190 -
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