184 2014 11 8 4 Chin J Transplant Electronic Edition November 2014Vol. 8No. 4 10 1 10 2003 12 1 43 28 ABO 5 UW HTK 3-0 + + + 9 8 CT 1992 1 1 2013 12 31 Kaplan-Meier 2014 5 10 3 Ⅰ ~ Ⅱ 9 65% 5 3. 5 1992 2013 26 44 44 1 3 5 39. 4% 36. 7% 30. 6% Evaluation of current combined heart-lung transplantation status in China and 10 years follow-up experience of a patient Yang ShouguoChen HaoYang ZhaohuaZhang HongqiangWang Fanshun Zhuang YaminWang Chunsheng. Department of Cardiothoracic SurgeryZhongshan Hospital of Fudan Universitythe Shanghai Institute of Cardiovascular DiseasesTransplantation Center of Fudan UniversityShanghai 200032China Corresponding authorwang ChunshengEmailwang. chunsheng@ zs-hospital. sh. cn Abstract Objective To evaluate the cardiopulmonary allografts function on a heart-lung transplantation patient survived more than 10 years at Zhongshan Hospital and to summarize the status and results of current heart-lung transplantation in China. Methods A homologous heart-lung transplantation was performed on a femalediagnosed as Eisenmenger' s syndrome secondary to congenital atrial septal defect on December 2003. Heart-lung allograft was preserved with 1000 ml UW solution and 3000 ml HTK solution. Postoperative immunosuppressive therapies were managed with daclizumab + cyclosporine A + mycophenolate mofetil + corticosteroids. Cyclosporine A was transferred to tacrolimus at the 9th month and corticosteroids was withdrew at the 8th years postoperative. Prophylaxis against virus was managed with oral Valacicloviri for 3 months. Echocardiogrampulmonary DOI10. 3877 /cma. j. issn. 1674-3903. 2014. 04. 003 14XD1401000 200032 Emailwang. chunsheng@ zs-hospital. sh. cn
2014 11 8 4 Chin J Transplant Electronic Edition November 2014Vol. 8No. 4 185 function and thoracic CT were followed-up periodically. Literatures on clinical heart-lung transplantation between January 1992 and December 2013 in China were retrieved and analyzed attentively. Results The patient survived operation and experienced normal daily life during the follow-up of 10 years and 3 months. Echocardiogram showed left ventricular ejection fraction of 65%. Pulmonary function examination exhibited with signs of small airway obstruction. Howeverno severe acute allograft rejection episode was experienced. The patient was complicated with two episodes of pneumonia at the 5th week and 3. 5 years and both were cured. A total of 44 heart-lung transplantations were completed at 26 transplant centers in China mainland. Eisenmenger' s syndrome secondary to congenital heart diseases constituted most of the etiologies. The actuarial 1-yr3-yr5-yr survival rate was 39. 3% 36. 7% 30. 6% respectively. Infections and graft failure contributed to the main cause of death. Conclusion Excellent cardiopulmonary grafts preservationskilled operation technique carefully tailor immunosuppressive strategy and keep the balance of rejection and infection were key factors of long-term survival for heart-lung transplantation. Key words Heart-lung transplantation Long-term result Eisenmenger's syndrome 5 1. 2 2013 3. 2 1 1000 ml 4 UW 3000 ml HTK 2014 5 3-0 10 223 min 195 + + + 20 50 mg 2 1 5 200 μg /L 3 1 100 ~ 200 μg /L 9 8 ~ 1. 1 20 μg /L 8 43 1993 20 ppm E1 30 ng kg - 1 min - 1 2003 6 3 2 1 3 Swan-Ganz 130 mmhg 1 mmhg = 0. 133 kpa 1. 3 14 Wood MasterScreen PFT Jaeger 2003 12 17 CT 28 ABO
186 2014 11 8 4 Chin J Transplant Electronic Edition November 2014Vol. 8No. 4 1. 4 1992 1 1 2013 12 31 1 4. 5 1 4. 5 9 2 9 CT 1 1. 5 SPSS13. 0 Kaplan-Meier 2 2. 1 2014 5 10 3 10 Ⅰ ~ Ⅱ 1 1 a b. 7 CT c d. 9 CT 1 CT 2. 3 1 10 9 mm mm mm mmhg 1 1 d 0. 65 21 39 35 38 92% ~ 94% 1 0. 72 23 44 29 25 6 0. 70 29 49 38 27 5 1 0. 86 20 46 39 33 3. 5 CT 3 0. 78 22 41 31 27 4. 5 0. 78 24 45 35-9 0. 65 26 43 35-1 mmhg = 0. 133 kpa-. 2. 4 78 2. 2 2-79 1992 2013 26 44 1 4 2 10 L L FEF50% L /s FEF25% L /s % 1. 0 1. 52 0. 517 3. 43 0. 745 55. 92 0. 42 0. 113 0. 16 0. 103 4. 5 1. 65 0. 563 2. 90 0. 626 55. 76 0. 45 0. 122 0. 17 0. 119 9. 0 1. 49 0. 510 2. 76 0. 593 55. 03 0. 42 0. 117 0. 16 0. 122. 1 FEV1 /FVC FEF50%. 50% FEF25%. 25%
2014 11 8 4 Chin J Transplant Electronic Edition November 2014Vol. 8No. 4 187 4 4 3 4 22 1 ~ 1 3 81. 7% 63. 0% 50. 8% 3 17 ~ 35 1 71. 4% 9. 5% 2 ~ 3 9. 5% 2. 4% 2. 4% 4. 8% + + 63 65. 5% + + 1992 2013 24. 1% 1 3 5 44 3 39. 4% 36. 7% 30. 6% 2 50% 44 29 5 23 3 10 4 3-4 3 2 1 9 1 2 3 1992 12 2013 10 44 Kaplan-Meier 2 3 4 1 2011 12 2 4 310 2002 100 1 4 000 CMV-IgM 2003 2006 3 2-3 CMV
188 2014 11 8 4 Chin J Transplant Electronic Edition November 2014Vol. 8No. 4 2 J 3 B J 4 J 2013 39121476-1477. 6 2013 346 380-381. 7. J. 2013 382 212-215. 8 1 J 2011 279 1689. 9 J 2011 325 276-280. HTK E1 10 2010 504027. 11 J E1 2008 231 9-16. E1 12 80 J. 2010 347 668-669. 13 J. 2010 25121145-1146. 81-83 14 27% E1 84 15 16 17 J 2009 18 J. 2005 19252347-2348. 19 2002 241 52-53. 1 20. X CT J. 2008 254 395. 21 J 8 473-475. 22 J. 2009 8473-476. 23 2005 261 6-8. 24 1 Yusen RDChristie JDEdwards LBet al. The registry of the International Society for Heart and Lung Transplantationthirtieth adult lung and heart-lung transplant report 2013focus themeage J. J Heart Lung Transplant2013 3210 965-978.. 1 3. 2007 171 91-92... 2005 2610630... 2006 86463306-3308. 5. J.. J. 1 8. 5..... 1 J...... J. 2009 121152.. J. 2001 222 116.. 2 J. 2009 83 32-34... 6487-489.. 1. 1 J. 1.. 2007 28.. J.. J. 2004 256 335. 25. J. 2003 223 138. 26. J. 1997 172 125. 27. J. 2001 213 189-190. 28.
2014 11 8 4 Chin J Transplant Electronic Edition November 2014Vol. 8No. 4 189 J. 2005 253 240. 29. J 1996 256 361-363. 30. 56. J. 2006 45 364-366.. 57. J. 2006 21111024-1025. J. 2008 155 588-589. 31. 58. J. J. 2009 24181672-1673. 2009 6385-386. 32. J. 59. 1 2005 204 384-385. J. 2005 256 1165 1169. 33. J. 60. 1 J. 2001 162 151-152. 2004 202 87-88. 34. 61. J. J. 2008 432 168-169. 2002 184 249. 35. 62. J. 2000 163 122. J. 2007 30s1 139. 36. J. 63. 2000 1612632. 5 J. 37. 2007 12 8-12. J. 1999 284 317. 64. 38. 1 J. 2005 122 79-80. J. 2006 126 384-387. 65. 39. 1 J. 2004 112 1-4. J. 2007 214 1031-1032. 40 J. 2009 15222177-2179. 41. J. 2005 11191659-1660.. 1 J. 2004 201 48. J. 2009 15212057-2058. 42. 1 J. 2007 52 90. 43. 1 J. 2006 276 536-537. 44. 1 J. J. 2005 5 10 44-2006 411 117-118. 46. 45. J. 71. 2006 51 38-39. 46 J. 2002 232 111-113. 47 J. 2007 87211493-1495. 48 J. 2009 89211512. 49 J. 2007 87171165-1168. 50. 1 72. J. 2002 235 306-307.. 73. J. 2005 267 439.. 74. J.. 75. J. 2006 275 294-296.. 76. J. 2005 8511759. J. 2007 285 309-310. 51. LPD 77. J. 2005 30 2 215- J. 2006 217. 279 563-564. 52. E1 78. J. J. 2005 73 325-327. 2009 143 417-419. 53. 1 79. 184 h J. 2000 165 15-16. 54. 2 2009.. 2007 131894-95. 80 Chiang CHWu KYu CPet al. Hypothermia and prostaglandin. 1 J. E1produce synergistic attenuation of ischemia-reperfusion lung J 55 2005 119 1246. 66. 1 67. 68. J. 2007 191 7-8. 69. J. 2004 303 173-175. 70. J. 2008 25 38-40. 2000 215 313. C. 2009
190 2014 11 8 4 Chin J Transplant Electronic Edition November 2014Vol. 8No. 4 injury J. Am J Respir Crit Care Med1999 1604 1319-1323. 81 Takashima SKoukoulis GInokawa Het al. Inhaled nitric oxide reduces ischemia-reperfusion injury in rat lungs from non-heartbeating donors J. J Thorac Cardiovasc Surg2006 1321 132-139. 82 Pabla RBuda AJFlynn DMet al. Nitric oxide attenuates neutrophil-mediated myocardial contractile dysfunction after ischemia and reperfusion J. Circ Res1996 781 65-72. 83 Cornfield DNMilla CEHaddad IYet al. Safety of inhaled nitric oxide after lung transplantation J. J Heart Lung Transplant 2003 228 903-907. 84 Radovancevic BVrtovec BThomas CDet al. Nitric oxide versus prostaglandin E1 for reduction of pulmonary hypertension in heart transplant candidatesj. J Heart Lung Transplant2005 246 690-695. 2014-05-31. 10 J /CD. 2014 84 184-190.