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Vol. 54. Num. 6.June 2018
Pages 301-354
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Vol. 54. Num. 6.June 2018
Pages 301-354
Original Article
DOI: 10.1016/j.arbr.2018.04.007
Lung Transplantation in Cystic Fibrosis and the Impact of Extracorporeal Circulation
El trasplante pulmonar en la fibrosis quística y la influencia de la circulación extracorpórea
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Alberto Jaureguia,
Corresponding author
ajauregui@vhebron.net

Corresponding author.
, Maria Deua, Laura Romeroa, Antonio Romanb, Antonio Morenoc, Manuel Armengold, Juan Soléa
a Servicio de Cirugía Torácica, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Spain
c Servicio de Neumología Pediátrica, Hospital Universitario Vall d’Hebron, Barcelona, Spain
d Servicio de Cirugía General, Hospital Universitario Vall d’Hebron, Barcelona, Spain
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Figures (6)
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Tables (5)
Table 1. Univariate Analysis of Risk Factors for Mortality According to the Cox Proportional Hazards Method.
Table 2. Actuarial Survival by Different Nutritional Grades.
Table 3. Comparison of Pulmonary functions test by need of ECC.
Table 4. Univariate Analysis of Risk Factors for ECC According to the Cox Proportional Hazards Method.
Table 5. Multivariate Analysis of ECC Risk Factors. Final Cox's Proportional Hazards Regression Model With Statistically Significant Variables in the Univariate Analysis.
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Abstract
Introduction

Lung disease is the major cause of death among cystic fibrosis (CF) patients, affecting 80% of the population. The impact of extracorporeal circulation (ECC) during transplantation has not been fully clarified. This study aimed to evaluate the outcomes of lung transplantation for CF in a single center, and to assess the impact of ECC on survival.

Methods

We performed a retrospective observational study of all transplanted CF patients in a single center between 1992 and 2011. During this period, 64 lung transplantations for CF were performed.

Results

Five- and 10-year survival of transplanted patients was 56.7% and 41.3%, respectively. Pre-transplantation supplemental oxygen requirements and non-invasive mechanical ventilation (NIMV) do not seem to affect survival (P=.44 and P=.63, respectively). Five- and 10-year survival among patients who did not undergo ECC during transplantation was 75.69% and 49.06%, respectively, while in those did undergo ECC during the procedure, 5- and 10-year survival was 34.14% and 29.87%, respectively (P=.001). PaCO2 is an independent risk factor for the need for ECC.

Conclusions

The survival rates of CF patients undergoing lung transplantation in our hospital are similar to those described in international registries. Survival is lower among patients receiving ECC during the procedure. PaCO2 is a risk factor for the need for ECC during lung transplantation.

Keywords:
Cystic fibrosis
Lung transplantation
Extracorporeal circulation
Resumen
Introducción

La enfermedad pulmonar es la principal causa de mortalidad en el 80% de los pacientes con fibrosis quística (FQ). La influencia de la circulación extracorpórea (CEC) no está completamente establecida. Los objetivos son evaluar los resultados del trasplante pulmonar por FQ en un solo centro y la influencia de la CEC sobre la supervivencia de estos pacientes.

Métodos

Estudio observacional retrospectivo de todos los pacientes afectados de FQ trasplantados en un solo centro entre 1992 y 2011. En este período se han realizado 64 trasplantes pulmonares por FQ.

Resultados

La supervivencia de los pacientes trasplantados a los 5 y 10 años fue del 56,7 y el 41,3%, respectivamente. El requerimiento de oxígeno suplementario previo al trasplante no parece afectar a la supervivencia (p=0,44), al igual que los pacientes que se trasplantaron con ventilación mecánica no invasiva (p=0,63). La supervivencia a los 5 y 10 años para los pacientes que no se trasplantan con CEC es del 75,69 y el 49,06%, respectivamente, mientras que los que se trasplantan bajo CEC tienen un supervivencia a los 5 y 10 años del 34,14 y el 29,87%, respectivamente (p=0,001). La PaCO2 es un factor de riesgo independiente para la necesidad de CEC.

Conclusiones

Los pacientes con FQ trasplantados pulmonares en nuestro centro tiene una supervivencia similar a la descrita por los registros internacionales. Los pacientes trasplantados bajo CEC tienen una menor supervivencia. La PaCO2 es factor de riesgo de necesidad de CEC durante el trasplante pulmonar.

Palabras clave:
Fibrosis quística
Trasplante pulmonar
Circulación extracorpórea

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