Introduction

Minimally invasive (MI) approaches to lung transplantation (LTx) offer the prospect of faster recovery compared to traditional incisions, however, little data exist describing the impact of surgical technique on early outcomes and analgesia use.

Methods

A prospectively maintained institutional registry identified 170 patients who underwent LTx between 01/2017 and 06/2022. Post-COVID acute respiratory distress syndrome, repeat, and multiorgan transplants were excluded (n=27) leaving 37 MILTx and 106 traditional LTx patients. Propensity score matching by age, sex, body mass index, diagnosis, lung allocation score, double vs. single lung, hypertension, diabetes, and hospitalization status created 37 pairs.

Results

Before matching, MILTx patients were more often male (70% vs 43%) and more likely to receive grafts from younger (31 vs 42 years), circulatory death donors (19% vs 6%) compared with traditional LTx patients (all p<0.05). After matching, there were no differences in graft warm ischemia or operative duration (both p>0.05). Postoperatively, MILTx experienced shorter ICU (4.3 [IQR 3.1-5.5] vs 8.2 [IQR 3.7-10.8] days) and hospital lengths of stay (LOS) (13 [IQR 11-15] vs 17 [IQR 12-25] days) (both p<0.05). Among patients surviving to discharge, MILTx patients required fewer opioid prescriptions at discharge (38% vs 66%, p=0.008) and had improved pulmonary function at 3-months (FEV1 82 [IQR 72-102] vs 77 [IQR 52-88] % predicted; FVC 78 [IQR 65-92] vs 70 [IQR 62-80] % predicted] (both p<0.05).

Conclusion

Minimally invasive LTx techniques demonstrate potential advantages over traditional approaches, including reduced ICU and hospital LOS, lower opioid use on discharge, and improved early pulmonary function. Word count: 250/250

中文翻译：

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微创肺移植对早期结果和镇痛使用的影响：一项匹配队列研究

介绍

与传统切口相比，微创（MI）肺移植（LTx）方法提供了更快恢复的前景，然而，很少有数据描述手术技术对早期结果和镇痛使用的影响。

方法

前瞻性维护的机构登记册确定了 170 名在 2017 年 1 月至 2022 年 6 月期间接受 LTx 的患者。排除了新冠肺炎后急性呼吸窘迫综合征、重复和多器官移植 (n=27)，留下 37 名 MILTx 患者和 106 名传统 LTx 患者。根据年龄、性别、体重指数、诊断、肺分配评分、双肺与单肺、高血压、糖尿病和住院状况进行倾向评分匹配，创建了 37 对。

结果

在匹配之前，与传统 LTx 患者相比，MILTx 患者通常为男性（70% vs 43%），并且更有可能接受年轻（31 岁 vs 42 岁）、循环死亡捐献者（19% vs 6%）的移植物（所有 p< 0.05）。匹配后，移植物热缺血或手术持续时间没有差异（均p>0.05）。术后，MILTx 的 ICU 时间较短（4.3 [IQR 3.1-5.5] vs 8.2 [IQR 3.7-10.8] 天），住院时间 (LOS) 较短（13 [IQR 11-15] vs 17 [IQR 12-25] 天） （均 p<0.05）。在存活出院的患者中，MILTx 患者出院时需要的阿片类药物处方较少（38% vs 66%，p=0.008），并且 3 个月时肺功能得到改善（FEV1 82 [IQR 72-102] vs 77 [IQR 52-88] ] % 预测；FVC 78 [IQR 65-92] 与 70 [IQR 62-80] % 预测]（均 p<0.05）。

结论

微创 LTx 技术显示出优于传统方法的潜在优势，包括减少 ICU 和医院住院时间、出院时减少阿片类药物使用以及改善早期肺功能。字数：250/250