实用临床医药杂志2025，Vol.29Issue(24)：30-35,42,7.DOI:10.7619/jcmp.20256240
肺移植术后早期原发性移植物功能丧失的危险因素分析及预后评价
Analysis of risk factors and prognostic evaluation of early primary graft dysfunction after lung transplantation
摘要
Abstract
Objective To explore the risk factors for early primary graft dysfunction(PGD)after lung transplantation,analyze the dose-effect relationship between cold ischemia time and PGD severi-ty,and evaluate the impact of PGD on patient's short-term and long-term prognosis.Methods A ret-rospective analysis was conducted on the clinical data of 156 patients who underwent lung transplanta-tion in the hospital from January 2020 to December 2024.Based on the occurrence of PGD within 72 h after surgery,patients were divided into PGD group(n=42)and non-PGD group(n=114).Data on donor characteristics,recipient baseline information,surgery-related indicators,and postoperative com-plications were collected.Univariate analysis and multivariate Logistic regression models were used to screen independent risk factors for PGD occurrence.Survival curves were plotted using the Kaplan-Meier method,and the Log-rank test was employed to compare the survival rates between the two groups.Additionally,the Cox proportional hazards regression model was used to analyze the impact of PGD on patient's prognosis.Results Among the 156 patients,the incidence rate of PGD was 26.9％(42/156).Univariate analysis revealed that donor age＞55 years,donor smoking history 20 packs per year,donor oxygenation index＜300 mmHg,recipient preoperative history of chronic obstructive pulmonary disease(COPD),recipient preoperative creatinine＞110 μmol/L,cold is-chemia time＞6 h,surgery time＞4 h,and the use of cardiopulmonary bypass(CPB)were poten-tial risk factors for PGD occurrence(P＜0.05).Multivariate Logistic regression analysis showed that donor age＞55 years(OR=3.215,95％CI,1.423 to 7.241,P=0.005),cold ischemia time＞6 h(OR=2.897,95％CI,1.268 to 6.614,P=0.012),recipient preoperative creatinine＞110 μmol/L(OR=2.534,95％CI,1.098 to 5.827,P=0.030),and CPB use(OR=3.012,95％CI,1.305 to 6.928,P=0.010)were independent risk factors for PGD occurrence.Survival analysis indicated that the 30-day,1-year,and 3-year survival rates of patients in the PGD group were 71.4％,52.4％and 38.1％respectively,which were significantly lower than 92.1％,83.3％and 75.4％respectively in the non-PGD group(Log-rank x2=28.643,P＜0.001).Cox regression analysis demonstrated that PGD was an independent risk factor for postoperative death in patients(HR=3.125,95％CI,1.876 to 5.198,P＜0.001).Conclusion Donor age＞55 years,cold ischemia time＞6 h,recipient preoperative renal insufficiency(creatinine＞110 μmol/L),and CPB use are independent risk factors for early PGD after lung transplantation.PGD significantly re-duces patient's short-term and long-term survival rates.Clinically,it is necessary to optimize donor selection,shorten cold ischemia time,improve recipient preoperative renal function,and use CPB cautiously to reduce the incidence rate of PGD and improve patient's prognosis.关键词
肺移植/原发性移植物功能丧失/危险因素/预后/回顾性研究/围术期管理/缺血-再灌注损伤/生存分析Key words
lung transplantation/primary graft dysfunction/risk factors/prognosis/retro-spective study/perioperative management/ischemia-reperfusion injury/survival analysis分类
医药卫生引用本文复制引用
焦健方,张广健..肺移植术后早期原发性移植物功能丧失的危险因素分析及预后评价[J].实用临床医药杂志,2025,29(24):30-35,42,7.基金项目
国家自然科学基金(82172280) （82172280）
陕西省自然科学基金(2024JC-YBQN-0972) （2024JC-YBQN-0972）
