[Abstract]It is an effective way of constructing a lung transplantation quality control system suitable for China's national conditions to break through the many dilemmas in China. Under the leadership of the National Quality Control Center, a stage-by-stage and full-scale quality control system for lung transplantation in China has been gradually constructed and extended to many lung transplantation centers nationwide, which has strongly promoted the development of lung transplantation in China. This article outlines the construction, promotion and experience of China's lung transplantation quality control system, aiming to provide reference for further development of relevant measures to promote the homogenization of lung transplantation in China.
ObjectiveProlonged mechanical ventilation (PMV) is a prognostic marker for short-term adverse outcomes in patients after lung transplantation.The risk of prolonged mechanical ventilation after lung transplantation is still not clear. The study to identify the risk factors of prolonged mechanical ventilation (PMV) after lung transplantation.Methods This retrospective observational study recruited patients who underwent lung transplantation in Wuxi People’s Hospital from January 2020 to December 2022. Relevant information was collected from patients and donors, including recipient data (gender, age, BMI, blood type, comorbidities), donor data (age, BMI, time of endotracheal intubation, oxygenation index, history of smoking, and any comorbidity with multidrug-resistant bacterial infections), and surgical data (surgical mode, incision type, operation time, cold ischemia time of the donor lung, intraoperative bleeding, and ECMO support), and postoperative data (multi-resistant bacterial lung infection, multi-resistant bacterial bloodstream infection, and mean arterial pressure on postoperative admission to the monitoring unit). Patients with a duration of mechanical ventilation ≤72 hours were allocated to the non-prolonged mechanical ventilation group, and patients with a duration of mechanical ventilation>72 hours were allocated to the prolonged mechanical ventilation group. LASSO regression analysis was applied to screen risk factors., and a clinical prediction model for the risk of prolonged mechanical ventilation after lung.ResultsPatients who met the inclusion criteria were divided into the training set and the validation set. There were 307 cases in the training set group and 138 cases in the validation set group. The basic characteristics of the training set and the validation set were compared. There were statistically significant differences in the recipient’s BMI, donor’s gender, CRKP of the donor lung swab, whether the recipient had pulmonary infection before the operation, the type of transplantation, the cold ischemia time of the donor lung, whether ECMO was used during the operation, the duration of ECMO assistance, CRKP of sputum, and the CRE index of the recipient's anal test (P<0.05). 2. The results of the multivariate logistic regression model showed that female recipients, preoperative mechanical ventilation in recipients, preoperative pulmonary infection in recipients, intraoperative application of ECMO, and the detection of multi-drug resistant Acinetobacter baumannii, multi-drug resistant Klebsiella pneumoniae and maltoclomonas aeruginosa in postoperative sputum were independent risk factors for prolonged mechanical ventilation after lung transplantation. The AUC of the clinical prediction model in the training set and the validation set was 0.838 and 0.828 respectively, suggesting that the prediction model has good discrimination. In the decision curves of the training set and the validation set, the threshold probabilities of the curves in the range of 0.05-0.98 and 0.02-0.85 were higher than the two extreme lines, indicating that the model has certain clinical validity.ConclusionsFemale patients, Preoperative pulmonary infection, preoperative mechanical ventilation,blood type B, blood type O, application of ECMO assistance, multi-resistant Acinetobacter baumannii infection, multi-resistant Klebsiella pneumoniae infection, and multi-resistant Stenotrophomonas maltophilia infection are independent risk factors for PMV (prolonged mechanical ventilation) after lung transplantation.
Lung transplantation has become an effective treatment for various end-stage lung diseases, which can significantly improve the quality of life and prolong the survival time of patients. However, there are still many challenges in the postoperative management of lung transplantation, which pulmonary infection is the primary factor affecting the survival and quality of life of recipients. This article reviews the common infection types and risk factors of lung transplantation recipients at home and abroad, in order to provide reference for the prevention and treatment of clinical lung transplantation infection.
Objective To investigate the impact of intraoperative red blood cell (RBC) transfusion volume on postoperative oxygenation index in lung transplant recipients. Methods A retrospective analysis was conducted on the clinical data of lung transplant recipients at Wuxi People’s Hospital Affiliated to Nanjing Medical University from 2021 to 2023. Patients were divided into a non-severe primary graft dysfunction (PGD) group and a severe PGD group based on whether their oxygenation index was greater than 200 mm Hg at postoperative 0 h, 24 h, and 48 h. General data and intraoperative RBC transfusion volumes were compared between the two groups to assess their effects on postoperative oxygenation indices at 0 h, 24 h, and 48 h. A binary logistic regression model was constructed to explore the effect values [odds ratios (OR) and their 95% confidence intervals (CI) ] of RBC transfusion volume on oxygenation status at different postoperative time points (0 h, 24 h, 48 h), and the area under the receiver operating characteristic curve (AUC) was calculated to evaluate diagnostic efficacy. Results A total of 351 patients were included, comprising 260 males and 91 females, aged 20 to 77 years. At postoperative 0 h, the OR for intraoperative RBC transfusion was 1.486 (95%CI, P=0.061); at postoperative 24 h, the OR was 3.111 (95%CI, P<0.001); and at postoperative 48 h, the OR was 1.583 (95%CI, P=0.038), indicating that the oxygenation status of lung transplant recipients was significantly affected by the volume of intraoperative transfusion over time. Furthermore, a transfusion volume greater than 975 mL significantly impacted oxygenation at postoperative 24 h and 48 h. Conclusion The volume of intraoperative RBC transfusion has a significant effect on oxygenation status at 24 h and 48 h post-surgery. The amount of RBC transfusion during lung transplantation is associated with the occurrence of severe PGD, and controlling RBC transfusion volume during the procedure may help reduce the incidence of severe PGD.