Originales
Trasplante pulmonar en enfermedades supurativasLung transplant therapy for suppurative diseases

https://doi.org/10.1157/13074591Get rights and content

Objetivo

El trasplante pulmonar es una opción terapéutica válida para pacientes con bronquiectasias. El objetivo de nuestro trabajo ha sido analizar nuestra experiencia en estos pacientes y comparar los resultados entre los pacientes con fibrosis quística y bronquiectasias de otra etiología.

Pacientes y método

Se ha realizado un estudio retrospectivo de los pacientes trasplantados por bronquiectasias para analizar las características demográficas, funcionales y aspectos microbiológicos antes y después del trasplante, así como la supervivencia.

Resultados

Entre 1991 y 2002 trasplantamos a 171 pacientes, de los cuales 44 presentaban enfermedad pulmonary supurativa (27 fibrosis quística y 17 bronquiectasias de otras etiologías). No había diferencias significativas en las variables demográficas entre ambos grupos. En el momento del trasplante la función pulmonar mostraba grave obstrucción bronquial (volumen espiratorio forzado en el primer segundo: 808 ± 342 ml; capacidad vital forzada: 1.390 ± 611 ml) e insuficiencia respiratoria (presión arterial de oxígeno: 52 ± 10 mmHg; presión arterial de anhídrido carbónico: 48 ± 9 mmHg). Sólo la presión arterial de oxígeno fue significativamente inferior en los pacientes con bronquiectasias de etiología diferente de la fibrosis quística. El 91% de los pacientes presentaba colonización de la vía aérea; el germen más frecuente fue Pseudomona spp. (64%), que en un 9% de los casos fue multirresistente. En el postoperatorio inmediato se aislaron gérmenes en el 59% de los casos; la mitad de ellos eran los mismos que se habían aislado antes del trasplante. Un año después del trasplante pulmonar, un 34% de los pacientes seguían mostrando colonización bronquial. La supervivencia al año fue del 79% y a los 5 años del 49%, sin diferencias significativas entre los pacientes con fibrosis quística y el resto de las enfermedades supurativas, ni entre los pacientes con o sin colonización por Pseudomonas spp. Sólo 2 pacientes fallecieron por neumonía bacteriana en el primer mes del trasplante pulmonar.

Conclusiones

A pesar de que la colonización de la vía aérea de los pacientes con enfermedad supurativa complica el manejo tras el trasplante pulmonar, los resultados en terminus de supervivencia son buenos.

Objective

Lung transplantation is a valid therapeutic approach for patients with bronchiectasis. The objective of the present study was to evaluate our experience with bronchiectasis patients and compare the results in patients with cystic fibrosis to results in those with bronchiectasis caused by other processes.

Patients and method

We carried out a retrospective study of bronchiectasis patients treated by lung transplantation in order to analyze demographic, functional and microbiological characteristics before and after transplantation, and survival.

Results

From 1991 to 2002 lung transplants were performed on 171 patients, 44 of whom had suppurative lung disease (27 had cystic fibrosis and 17 had bronchiectasis caused by other processes). There were no significant differences in the demographic variables between the 2 groups. At transplantation, lung function variables showed severe bronchial obstruction (mean [SD] forced expiratory volume in 1 second of 808 [342] mL and forced vital capacity of 1,390 [611] mL) and respiratory insufficiency (PaO2 at 52 [10] mm Hg and PaCO2 at 48 [9] mm Hg). Only PaO2 was significantly lower in patients with bronchiectasis from causes other than cystic fibrosis. Airway colonization was present in 91% of the patients; Pseudomonas spp germs were detected in 64% of the cases and were multiresistant in 9%. In the early postoperative period germs were isolated in 59% of the cases, half of which involved the same germ as had been isolated before transplantation. One year after lung transplantation, 34% of the patients continued to have bronchial colonization. Survival at 1 year was 79% and at 5 years, 49%, with no significant difference between the patients with cystic fibrosis and those with other suppurative diseases, nor between the patients with and without Pseudomonas colonization. Only 2 patients had died of bacterial pneumonia at 1 month after transplantation.

Conclusions

Although airway colonization in patients with suppurative diseases complicates postoperative management, the results in terms of survival are good.

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Copyright © 2005 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier España S.L. All rights reserved.