Comparative outcomes of lung volume reduction surgery and lung transplantation: a systematic review and meta-analysis.

Autor:	Ahmad D; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA., Ferrell BE; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.; Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY, USA., Saxena A; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA., Jimenez DC; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA., O'Malley TJ; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA., Dispagna MA; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA., Grenda T; Division of Thoracic & Esophageal Surgery, Thomas Jefferson University, Philadelphia, PA, USA., Tchantchaleishvili V; Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2023 Jul 31; Vol. 15 (7), pp. 3627-3635. Date of Electronic Publication: 2023 Jul 17.
DOI:	10.21037/jtd-23-63
Abstrakt:	Background: Lung volume reduction (LVR) and lung transplantation (LTx) have been used in different populations of chronic obstructive pulmonary disease (COPD) patients. To date, comparative study of LVR and LTx has not been performed. We sought to address this gap by pooling the existing evidence in the literature. Methods: An electronic search was performed to identify all prospective studies on LVR and LTx published since 2000. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis. Results: The analysis included 65 prospective studies comprising 3,671 patients [LTx: 15 studies (n=1,445), LVR: 50 studies (n=2,226)]. Mean age was 60 [95% confidence interval (CI): 58-62] years and comparable between the two groups. Females were 51% (95% CI: 30-71%) in the LTx group vs. 28% (95% CI: 21-36%) in LVR group (P=0.05). Baseline 6-minute walk test (6MWT) and pulmonary function tests were comparable except for the forced expiratory volume in 1 second (FEV1), which was lower in the LTx group [21.8% (95% CI: 16.8-26.7%) vs. 27.3% (95% CI: 25.5-29.2%), P=0.04]. Postoperatively, both groups experienced improved FEV1, however post-LTx FEV1 was significantly higher than post-LVR FEV1 [54.9% (95% CI: 41.4-68.4%) vs. 32.5% (95% CI: 30.1-34.8%), P<0.01]. 6MWT was also improved after both procedures [LTx: 212.9 (95% CI: 119.0-306.9) to 454.4 m (95% CI: 334.7-574.2), P<0.01; LVR: 286 (95% CI: 270.2-301.9) to 409.1 m (95% CI: 392.1-426.0), P<0.01], however, with no significant difference between the groups. Pooled survival over time showed no significant difference between the groups. Conclusions: LTx results in better FEV1 but otherwise has comparable outcomes to LVR. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-63/coif). The authors have no conflicts of interest to declare. (2023 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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