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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

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Front. Med.    2022, Vol. 16 Issue (5) : 760-765    https://doi.org/10.1007/s11684-021-0899-5
RESEARCH ARTICLE
Outcomes of patients awaiting lung transplantation after the implementation of donation after brain death at a single Chinese center
Yuling Yang1,2, Xinnan Xu1, Ming Liu1, Yanfeng Zhao1, Yongmei Yu1, Xiaogang Liu1, Chang Chen1, Gening Jiang1, Wenxin He1()
1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China
2. Department of Cardiothoracic Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
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Abstract

Voluntary contribution has become the only source of donor lungs in China since 2015. To elaborate the outcomes of patients awaiting lung transplantation (LTx) after the implementation of donation after brain death, we performed a retrospective study that encompassed 205 patients with end-stage lung disease who registered for LTx at Shanghai Pulmonary Hospital from January 1, 2015 to January 1, 2021. A total of 180 patients were enrolled in the study. The median waiting time was 1.25 months. Interstitial lung disease (ILD) (103/180, 57.2%) and chronic obstructive pulmonary disease (COPD) (56/180, 31.1%) were the most common diseases in our study population. The mean pulmonary artery pressure (mPAP) of patients in the died-waiting group was higher than that of the survivors (53.29±21.71 mmHg vs. 42.11±18.58 mmHg, P=0.002). The mortality of patients with ILD (34/103, 33.00%) was nearly twice that of patients with COPD (10/56, 17.86%) while awaiting LTx (P=0.041). In the died-waiting group, patients with ILD had a shorter median waiting time than patients with COPD after being listed (0.865 months vs. 4.720 months, P=0.030). ILD as primary disease and mPAP > 35 mmHg were two significant independent risk factors for waitlist mortality, with hazard ratios (HR) of 3.483 (95% CI 1.311–9.111; P=0.011) and 3.500 (95% CI 1.435–8.536; P=0.006). Hence, LTx is more urgently needed in patients with ILD and pulmonary hypertension.

Keywords lung transplantation      donation after brain death      waitlist     
Corresponding Author(s): Wenxin He   
Just Accepted Date: 02 April 2022   Online First Date: 30 June 2022    Issue Date: 18 November 2022
 Cite this article:   
Yuling Yang,Xinnan Xu,Ming Liu, et al. Outcomes of patients awaiting lung transplantation after the implementation of donation after brain death at a single Chinese center[J]. Front. Med., 2022, 16(5): 760-765.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0899-5
https://academic.hep.com.cn/fmd/EN/Y2022/V16/I5/760
Variables All patients (N = 180) The alive-waiting group (N = 129) The died-waiting group (N = 51) Value P value
Age, year 60.37 ± 10.60 60.96 ± 10.19 58.88 ± 11.53 1.188a 0.237
BMI, kg/m2 21.18 ± 3.71 20.99 ± 3.58 21.83 ± 4.08 −1.183a 0.239
mPAP, mmHg 44.75 ± 19.87 42.11 ± 18.58 53.29 ± 21.71 −3.111a 0.002
Lung function testd
FEV1, % predicted 64.52 ± 26.32 66.75 ± 26.07 48.51 ± 23.26 2.200a 0.030
FVC, % predicted 54.67 ± 19.86 55.43 ± 19.95 49.16 ± 19.17 0.982a 0.329
Arterial blood gas analysis
PaO2, mmHg 74.00 ± 19.75 76.11 ± 20.16 68.48 ± 17.67 2.326a 0.021
PaCO2, mmHg 45.29 ± 13.60 45.71 ± 12.38 44.21 ± 16.45 0.653a 0.515
PF ratio, mmHg 244.34 ± 73.05 255.50 ± 70.61 215.18 ± 71.94 3.382a 0.001
Blood type, n (%) 1.027b 0.795
A 54 (30.00%) 38 (29.46%) 16 (31.37%)
B 51 (28.33%) 36 (27.91%) 15 (29.41%)
AB 17 (9.44%) 14 (10.85%) 3 (5.88%)
O 57 (31.67%) 41 (31.78%) 16 (31.37%)
Comorbidity
Hypertension, n (%) 27 (15.00%) 18 (13.95%) 9 (17.65%) 0.391b 0.532
DM, n (%) 23 (12.78%) 18 (13.95%) 5 (9.80%) 0.565b 0.452
Primary diseases, n (%) 4.161b 0.041
ILD, n (%) 103 (57.22%) 69 (53.49%) 34 (66.67%)
COPD, n (%) 56 (31.11%) 46 (35.66%) 10 (19.61%)
Otherse, n (%) 21 (11.67%) 14 (10.85%) 7 (13.73%)
Use of steroid, n (%) 32 (17.78%) 20 (15.50%) 12 (23.53%) 1.611b 0.204
Use of MV, n (%) 26 (14.44%) 12 (9.30%) 14 (27.45%) 9.742b 0.002
Waiting time, month 1.25 (0.58, 3.49) 1.40 (0.63, 3.25) 1.13 (0.37, 4.67) 3172.5c 0.710
Tab.1  Variables of patients with end-stage lung diseases waiting for LTx
Fig.1  Cum survival: survival of patients awaiting lung transplantation, determined by the Kaplan−Meier method. (A) Differences in survival between patients with PF ratio > 200 mmHg versus those with PF ratio ≤ 200 mmHg were statistically significant (P = 0.028). (B) Differences in survival between patients with mPAP ≤ 35 mmHg versus those with > 35 mmHg were statistically significant ( P = 0.001). (C) Differences in survival between patients with ILD versus those with COPD were statistically significant (P = 0.002). (D) No statistically significant difference in survival was found between patients requiring MV versus those not requiring MV (P = 0.414). mPAP, mean pulmonary arterial pressure; COPD, chronic obstructive pulmonary disease; ILD, interstitial lung disease; MV, mechanical ventilation; PF ratio, ratio of PaO2/FiO2.
Variablesa 　　　　　Univariate analysis 　　　　　Multivariate analysis
　　 P value 　　HR (95% CI) 　　 P value 　　HR (95% CI)
PF ratio, > 200 mmHg 　　0.032 　　0.527 (0.294−0.945) 　　0.563
ILD vs. COPD 　　0.001 　　3.922 (1.718−8.950) 　　0.011 　　3.483 (1.311−9.111)
mPAP, > 35 mmHg 　　0.002 　　3.612 (1.580−8.258) 　　0.006 　　3.500 (1.435−8.536)
Tab.2  COX proportional hazards analysis for all patients
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