Informations générales (source: ClinicalTrials.gov)
Optimization of Donor-Recipient Matching in Lung Transplantation (ADRTP)
Observational
Fondation Hôpital Saint-Joseph (Voir sur ClinicalTrials)
janvier 2022
décembre 2023
29 juin 2024
Lung transplantation is the curative treatment for end-stage respiratory failure
involving highly selected patients. In 2018, the International Transplant Registry counts
69200 lung transplants among 260 transplant centers. Between 2010 and June 2017, the
3-month survival rate of patients after lung transplantation is 90%. The causes of early
death are primary graft failure, renal failure, infections, acute rejection (cellular or
humoral), surgical complications. The median survival is 6.7 years and the median
conditioned survival at 1 year is 8.9 years. Bronchiolitis obliterans is the leading
cause of death after 1 year; it affects 10% more patients each year and peaks at 5 years
at more than 50% of transplanted patients. These results encourage transplant
professionals to continue their efforts to improve the prognosis of transplantation.
Among these, the optimization of graft matching, taking into account the characteristics
of the donor and the recipient, constitute a relevant avenue of study. Several donor
characteristics seem to play a role in the prognosis of the transplant. Survival at 12
months is significantly worse when the donor's age is greater than 50 years. There does
not appear to be a significant difference in donor cause of death. Recipients of a graft
exposed to smoking ≥ 20 pack-years have a 3% and 1.5% decreased survival at 1 and 5 years
postoperatively.
Similarly, the 5-year survival of patients with conditional 1-year survival is poorer in
case of other toxic exposures such as alcohol, cocaine, crack or marijuana. Analysis of
international registry data also suggests a negative association between post-transplant
survival and donor hypertension and diabetes. However, the biological mechanisms by which
these factors affect survival remain unknown. Graft ischemia time is significantly
associated with survival with a 5-year survival of 70% and 65% for grafts exposed to
ischemia ≥ 4 hours or less. The cumulative effect of donor hypertension and ischemia time
are appreciated by the fact that the best postoperative survival is observed in donors
without hypertension and graft ischemia time ≥ 4 hours. Graft size is also associated
with post-transplant prognosis, in front of a significant decrease in survival for
patients with emphysema, chronic obstructive pulmonary disease, alpha-1 antitrypsin
deficiency, transplanted with a smaller graft size.
This result is not found in patients transplanted for pulmonary fibrosis. One study has
also suggested the negative role of a gender mismatch between donor and recipient on
post-transplant survival, but there is currently no clear explanation for this result.
The presence of antibodies to the recipient's HLA system [DSA (donor-specific
antibodies)] in pre-transplant is a risk factor for hyperacute rejection and chronic
graft dysfunction. Thus, the choice of matching between the donor and the recipient
appears complex in view of the number of criteria to be taken into account which impact
the duration of post-transplant survival in the short and medium term. The objective of
the project is to develop a decision support tool, using artificial intelligence
algorithms, to assist the thoracic surgeon in identifying the patient, among those
registered on the team's waiting list, who could benefit most from a bi-pulmonary graft
offered by the Biomedicine Agency.
Etablissements
| Les établissements d'Île-de-France dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données | |||||
|---|---|---|---|---|---|
| GH PARIS SITE SAINT JOSEPH | Anne Buronfosse, MD | Contact (sur clinicalTrials) | |||
Critères
Tous
Inclusion Criteria:
- Patients who have received a bi-lung transplant performed by the Marie Lannelongue
lung transplant team between January 1, 2007 and April 30, 2021 All indications for
transplantation will be considered, including retransplantation.
- French-speaking patient
- Patients who have received a bi-lung transplant performed by the Marie Lannelongue
lung transplant team between January 1, 2007 and April 30, 2021 All indications for
transplantation will be considered, including retransplantation.
- French-speaking patient
- Patient is a minor (<18 years old) at the time of transplantation
- Patient's refusal to participate in the study
- Patient under guardianship or curatorship
- Patient deprived of liberty
- Patient under court protection
- Patient objecting to the use of his/her data for this research