بقاء بيماران پيوند ريه بيمارستان دكتر مسيح دانشوري

Survival of Lung Transplantation Patients in Masih Daneshvari Hospital

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﺩﺭﻣﺎﻥ ﻧﻬﺎﻳﻲ ﺑﺴﻴﺎﺭﻱ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺑﻴﻤﺎﺭﻱ ﭘﻴﺸﺮﻓﺘﻪ ﺭﻳﻮﻱ ﺍﺳﺖ. ﭘﻴﭽﻴﺪﮔﻲ ﺍﻳﻦ ﺭﻭﺵ، ﻛﻤﺒﻮﺩ ﺑﻴﻤﺎﺭﺍﻥ ﺩﻫﻨﺪﻩ، ﻛﻤﺒﻮﺩ ﻣﺮﺍﻛﺰ ﺗﺨﺼﺼﻲ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﻭ ﻫﺰﻳﻨﺔ ﺑﺎﻻﻱ ﺁﻥ ﺑﺮﺧﻲ ﺍﺯ ﻣﺸﻜﻼﺕ ﭘﻴﺶ ﺭﻭﻱ ﭘﻴﺸﺮﻓﺖ ﺍﻳﻦ ﺭﻭﺵ ﻫﺴﺘﻨﺪ. ﺑﺎ ﻭﺟﻮﺩ ﺍﻧﺠﺎﻡ ﺑﻴﺶ ﺍﺯ 30 ﻣﻮﺭﺩ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﺩﺭ ﻛﺸﻮﺭﻣﺎﻥ، ﺗﺎ ﺑﻪ ﺣﺎﻝ ﻣﻴﺰﺍﻥ ﺑﻘﺎﺀ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﮔﺰﺍﺭﺵ ﻧﺸﺪﻩ ﺍﺳﺖ. ﺍﺯ ﺍﻳﻨﺮﻭ، ﻫﺪﻑ ﺍﺯ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﮔﺰﺍﺭﺵ ﻣﻴﺰﺍﻥ ﺑﻘﺎﺀ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺩﻛﺘﺮ ﻣﺴﻴﺢ ﺩﺍﻧﺸﻮﺭﻱ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺑﺎﻧﻚ ﺍﻃﻼﻋﺎﺗﻲ ﺑﻴﻤﺎﺭﺍﻥ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺩﻛﺘﺮ ﻣﺴﻴﺢ ﺩﺍﻧﺸﻮﺭﻱ، ﺍﻃﻼﻋﺎﺕ ﺑﻴﻤﺎﺭﺍﻥ ﭘﻴﻮﻧﺪﻱ ﺩﺭ ﺳﺎﻝ ﻫﺎﻱ 1379 ﻟﻐﺎﻳﺖ 1388 ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪ. ﺍﻳﻦ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻳﻚ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺩﺍﻧﺸﮕﺎﻫﻲ ﺍﺳﺖ ﻭ ﻣﺮﻛﺰ ﺍﺭﺟﺎﻉ ﺑﺮﺍﻱ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﺩﺭ ﺍﻳﺮﺍﻥ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻴﺰﺍﻥ ﺑﻘﺎﺀ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺟﺪﺍﻭﻝ ﻋﻤﺮ ﻭ ﺭﻭﺵ ﻛﺎﭘﻼﻥ ﻣﺎﻳﺮ ﻣﺤﺎﺳﺒﻪ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ ﻣﺪﺕ ﻣﺬﻛﻮﺭ 33 ﺑﻴﻤﺎﺭ ﺗﺤﺖ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. 25 ﺑﻴﻤﺎﺭ ﻣﺮﺩ ﺑﻮﺩﻧﺪ ﻭ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﺁﻧﻬﺎ 15 ± 38 ﺳﺎﻝ ﺑﻮﺩ. ﻋﻠﻞ ﭘﻴﻮﻧﺪ ﻋﺒﺎﺭﺕ ﺑﻮﺩﻧﺪ ﺍﺯ: ﻓﻴﺒﺮﻭﺯ ﺭﻳﻮﻱ )22 ﻧﻔﺮ، 67%(، COPD )5 ﻧﻔﺮ، 15%(، ﺑﺮﻭﻧﺸﻜﺘﺎﺯﻱ 4 ﻧﻔﺮ، 12%(، ﻭ ﺳﻴﺴﺘﻴﻚ ﻓﻴﺒﺮﻭﺯﻳﺲ )2 ﻧﻔﺮ، 22 .(%6 ﻣﻮﺭﺩ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﻳﻚ ﻃﺮﻓﻪ ﻭ 11 ﻣﻮﺭﺩ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﺩﻭ ﻃﺮﻓﻪ ﺍﻧﺠﺎﻡ ﺷﺪ. ﻣﻴﺰﺍﻥ ﺑﻘﺎﺀ ﻳﻚ ﻭ ﭘﻨﺞ ﺳﺎﻟﻪ ﺗﻤﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻪ ﺗﺮﺗﻴﺐ 33 ﻭ 24 ﻭ ﻣﻴﺎﻧﮕﻴﻦ ﻭ ﻣﻴﺎﻧﻪ ﺑﻘﺎﺀ ﺁﻧﻬﺎ ﺑﻪ ﺗﺮﺗﻴﺐ 32 ﻭ 17 ﻣﺎﻩ ﺑﻮﺩ. ﺩﺭ ﺑﻴﻤﺎﺭﺍﻧﻲ ﻛﻪ ﭘﺲ ﺍﺯ ﺩﻭ ﻫﻔﺘﻪ ﺯﻧﺪﻩ ﻣﺎﻧﺪﻩ ﺑﻮﺩﻧﺪ، ﻣﻴﺰﺍﻥ ﺑﻘﺎﺀ ﻳﻚ ﻭ ﭘﻨﺞ ﺳﺎﻟﻪ ﺑﻪ ﺗﺮﺗﻴﺐ 51 ﻭ ﻣﻴﺎﻧﮕﻴﻦ ﻭ ﻣﻴﺎﻧﻪ ﺑﻘﺎﺀ ﺁﻧﻬﺎ ﺑﻪ ﺗﺮﺗﻴﺐ 45/8 ﻭ 20/8 ﻣﺎﻩ ﺑﻮﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻣﻄﺎﻟﻌﺔ ﺣﺎﺿﺮ ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﻣﻴﺰﺍﻥ ﻫﺎﻱ ﺑﻘﺎﺀ ﺑﻴﻤﺎﺭﺍﻥ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﺍﻳﻦ ﻣﺮﻛﺰ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺁﻣﺎﺭﻫﺎﻱ ﺟﻬﺎﻧﻲ ﺩﺭ ﺳﻄﺢ ﭘﺎﻳﻴﻦ ﺗﺮﻱ ﻗﺮﺍﺭ ﺩﺍﺭﻧﺪ. ﺍﮔﺮﭼﻪ ﺗﺠﺮﺑﻪ ﺟﺪﻳﺪ ﺟﺮﺍﺣﻲ ﭘﻴﻮﻧﺪ، ﻭﺿﻌﻴﺖ ﻧﺎﻣﻄﻠﻮﺏ ﺑﻴﻤﺎﺭﺍﻥ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ ﺍﺯ ﻧﻈﺮ ﻧﻮﻉ ﺑﻴﻤﺎﺭﻱ ﻭ ﺷﺪﺕ ﺁﻥ ﻭ ﻧﻴﺰ ﺧﺼﻮﺻﻴﺎﺕ ﻓﺮﺩﻱ ﺑﻴﻤﺎﺭﺍﻥ )ﺗﺤﺼﻴﻼﺕ ﻭ ﻭﺿﻌﻴﺖ ﺍﻗﺘﺼﺎﺩﻱ ﺍﺟﺘﻤﺎﻋﻲ ﭘﺎﻳﻴﻦ( ﺗﺎ ﺣﺪﻱ ﺗﻮﺿﻴﺢ ﺩﻫﻨﺪﻩ ﺍﻳﻦ ﻋﻠﻞ ﻫﺴﺘﻨﺪ، ﺍﻣﺎ ﺑﺮﻧﺎﻣﻪ ﺭﻳﺰﻱ ﺩﺭ ﺟﻬﺖ ﺍﺭﺗﻘﺎﻱ ﺑﻬﺒﻮﺩ ﺑﻘﺎﺀ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺿﺮﻭﺭﻱ ﺑﻪ ﻧﻈﺮ ﻣﻲ ﺭﺳﺪ.

Introduction & Objective: Lung transplantation is the ultimate treatment in many patients with advanced stages of pulmonary disease. Complexity, lack of donors, lack of specialized centers and the cost of the procedure are main barriers for its expansion. Although more than 30 lung transplantation have been done in our country, there is no report about the survival of these patients. We report here the survival rate of the patients who underwent lung transplantation at the research center of Masih Daneshvari Hospital. Materials & Methods: We used the database of lung transplantation research center of Masih Daneshvari Hospital, Tehran, Iran and extracted all cases of lung transplantation during 2000-2009 periods. Masih Daneshvari Hospital is a university based hospital and is the referral center for lung transplantation. We analyzed the survival of the patients using life table and Kaplan-Meier method. Results: 33 patients underwent lung transplantation during this period. 25 (76%) of them were male and the mean age of patients was 38 ± 15 yr. The causes of transplantation were: pulmonary fibrosis (22, 67%), COPD (5, 15%), bronchiectasis (4, 12%) and cystic fibrosis (2, 6%). Lung transplantation was single-sided in 22 (67%) patients and double-sided 11 (33%) in others. One- and five-year survival of the all patients was 33% and 24%, and the mean and median of patients' survival were 32 and 17 months, respectively. In patients who were alive after two weeks of transplantation, one- and five-year survival were 51% and 36% and the mean and median of patients' survival were 45.8 and 20.8 months, respectively. Conclusions: The patients’ survival was lower at our center than what was reported from other centers. However, when interpreting these results, one should notice that lung transplantation is very young in our center. Most of our transplantations were performed while the center was in learning curve. Also, bad clinical condition and more advance disease-status of the transplanted patients along with patients’ poor education and their low socioeconomic status that made them stop their medications and follow-up, could be the other reasons.