The 10 Years Experience of Lung Transplantation

폐 이식 수술의 10년 치험

  • Paik, Hyo-Chae (Department of Thoracic & Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine) ;
  • Hwang, Jung-Joo (Department of Thoracic & Cardiovascular Surgery, Eulji University Hospital, Eulji University) ;
  • Kim, Do-Hyung (Department of Thoracic & Cardiovascular Surgery, Eulji University Hospital, Eulji University) ;
  • Joung, Eun-Kyu (Department of Thoracic & Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Hae-Kyoon (Vascular Center, Daehang Hospital) ;
  • Lee, Doo-Yun (Department of Thoracic & Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine)
  • 백효채 (연세대학교 의과대학 영동세브란스병원 흉부외과) ;
  • 황정주 (을지의과대학교 을지대학병원 흉부외과) ;
  • 김도형 (을지의과대학교 을지대학병원 흉부외과) ;
  • 정은규 (연세대학교 의과대학 영동세브란스병원 흉부외과) ;
  • 김해균 (대항병원 정맥류혈관센터) ;
  • 이두연 (연세대학교 의과대학 영동세브란스병원 흉부외과)
  • Published : 2006.11.05

Abstract

Background: Lung transplantation is a definitive therapy for a variety of end stage lung diseases. Since 1996, we have performed thirteen cases of lung transplantation including two retransplantations, and we analyzed the outcomes, complications, and survivals of these patients. Material and Method: We retrospectively analyzed the medical records of thirteen cases from July, 1996 to July, 2005. Result: During the period, 11 patients had undergone 43 lung and heart-lung transplantations, and two patients had retransplantation due to allograft failure. Mean age of recipients were $45.2{\pm}10.7$ years(range, $25{\sim}59$). Early complications were bleeding, reperfusion injury, and infection and late complications were mainly infection and post-transplantation lymphoproliferative disease. Excluding the operative mortality, the mean survival period was 16.5 months($2{\sim}60$ months). Two retransplantations had been performed 2 weeks and 13 months after single lung transplantations. Conclusion: In order to achieve long term survival, early detection of complications and proper treatment in addition to surgical skills are necessary, and these efforts can promote better lung transplantation programs in the near future.

배경: 폐 이식 수술은 호흡부전을 동반한 말기 폐질환 환자에서 유용한 치료방법 중의 하나로 본원에서는 1996년 국내에서 처음으로 일측 폐 이식 수술을 성공한 이래로 현재까지 재 이식 2예를 포함한 총 13예의 폐 이식 수술을 시행하였다. 저자 등은 그동안 환자들의 수술성적 및 합병증, 생존율 등을 분석하고자 하였다. 대상 및 방법: 1996년 7월부터 2005년 7월까지 영동세브란스병원 흉부외과에서 폐 이식을 시행받은 13예, 11명의 환자(2명은 재 이식환자)를 대상으로 후향적으로 임상기록지를 분석하였다. 결과: 남녀비는 9:4, 평균연령은 $45.2{\pm}10.7$세(범위 $25{\sim}59$세)였으며, 폐기종 및 만성폐쇄성 폐질환이 5예로 가장 많았고, 동맥관 개존증으로 인한 아이젠맹거 증후군 2예, 폐섬유증, 폐고혈압, 림프관 평활근종증, 기관지확장증이 각 1예였다. 조기 합병증으로는 출혈, 이식 폐 부전, 감염이며 후기 합병증으로는 감염 및 이식 후 림프증식증이었다. 조기사망 3예를 제외한 평균생존기간은 16.5개월($2{\sim}60$개월)이었다. 재 이식 2예는 이식 폐의 기능 부전에 의하여 각각 첫 이식 후에 2주, 13개월째 시행 받았다. 결론: 폐 이식 수술 후 장기성적을 향상시키기 위해서는 수술술기의 향상뿐만 아니라 수술 후 집중적인 환자관리를 통하여 합병증을 조기에 발견하고 필요한 내과적, 외과적 처치를 즉시 시행하는 것이 예후에 좋은 영향을 미칠 것으로 생각된다.

Keywords

References

  1. Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med 1986;314:1140-5 https://doi.org/10.1056/NEJM198605013141802
  2. Trulock EP, Edwards LB, Taylor DO, Boucek MM, Keck BM, Hertz MI. Registry of the International Society for Heart and Lung Transplantation: twenty-second official adult lung and heart-lung transplant report-2005. J Heart Lung Transplant 2005;24:956-67 https://doi.org/10.1016/j.healun.2005.05.019
  3. Arcasoy SM, Kotloff RM. Lung transplantation. N Engl J Med 1999;340:1081-91 https://doi.org/10.1056/NEJM199904083401406
  4. International guidelines for the selection of lung transplant candidates. The American society for transplant physicians (ASTP)/American thoracic society (ATS)/European respiratory society (ERS)/international society for hear and lung transplantation (ISHLT). Am J Respir Crit Care Med 1998;158: 335-9 https://doi.org/10.1164/ajrccm.158.1.15812
  5. Fisher AJ, Dark JH, Corris PA. Improving donor lung evaluation: a new approach to increase organ supply for lung transplantation. Thorax 1998;53:818-20 https://doi.org/10.1136/thx.53.10.818
  6. Flume PA, Egan TM, Westerman JH, et al. Lung transplantation for mechanically ventilated patients. J Heart Lung Transplant 1994;13:15-21
  7. Baz MA, Palmer SM, Staples ED, Greer DG, Tapson VF, Davis DD. Lung transplantation after long-term mechanical ventilation: results and 1-year follow-up. Chest 2001;119:224-7 https://doi.org/10.1378/chest.119.1.224
  8. Meyers BF, Lynch JP, Battafarano RJ, et al. Lung transplantation is warranted for stable, ventilator-dependent recipients. Ann Thorac Surg 2000;70:1675-8 https://doi.org/10.1016/S0003-4975(00)01919-6
  9. Thabut G, Mal H, Cerrina J, et al. Graft ischemic time and outcome of lung transplantation. Am J Resp Crit Care Med 2005;171:786-91 https://doi.org/10.1164/rccm.200409-1248OC
  10. Ueno T, Snell GI, Williams TJ, et al. Impact of graft ischemic time on outcomes after bilateral sequential singlelung transplantation. Ann Thorac Surg 1999;67:1577-82 https://doi.org/10.1016/S0003-4975(99)00309-4
  11. Frost AE. Donor criteria and evaluation. Clin Chest Med 1997;18:231-7 https://doi.org/10.1016/S0272-5231(05)70374-9
  12. Puskas JD, Winton TL, Miller JD, Scavuzzo M, Patterson GA. Unilateral donor lung dysfunction does not preclude successful contralateral single lung transplantation. J Thorac Cardiovasc Surg 1992;103:1015-7
  13. Bando K, Paradis IL, Similo S, et al. Obliterative bronchiolitis after lung and heart-lung transplantation. An analysis of risk factors and management. J Thorac Cardiovasc Surg 1995;110:4-13 https://doi.org/10.1016/S0022-5223(05)80003-0
  14. Sundaresan S, Trulock EP, Mohanakumar R, Cooper JD, Patterson GA. Prevalence and outcome of bronchiolitis obliterans syndrome after lung transplantation. Ann Thorac Surg 1995; 60:1341-6 https://doi.org/10.1016/0003-4975(95)00751-6
  15. Edvards RH, Raab-Traub N. Alterations of the P53 gene in Epstein Barr virus associated immunodeficiency related lymphomas. J Virol 1994;68:1309-15
  16. Armitag JM, Kormos RL, Stuart RS, et al. Post trasnplant lumphproliferative disease in thoracic organ transplant patients: ten years of cyslosporine-based immunosuppression. J Heart Lung Transplant 1991;10:877-86
  17. Chang YS, Kim Y, Kim DY, et al. Two cases of post transplant lymphoproliferative disorder in lung transplant recipients. Korean J Intern Med 2004;19:276-81 https://doi.org/10.3904/kjim.2004.19.4.276
  18. King-Biggs MB. Acute pulmonary allograft rejection. Mechanisms, diagnosis, and management. Clin Chest Med 1997; 18:301-10 https://doi.org/10.1016/S0272-5231(05)70380-4
  19. Ramsey SD, Patrick DL, Lewis S, Albert RK, Raghu G. Improvement in quality of life after lung transplantation: a preliminary study. J Heart Lung Transplant 1995;14:870-7