RESUMO
Background: This study aims to evaluate the entire experience in heart-lung transplantation (HLTx) in a country of the European Union with 47 million inhabitants according to the etiologies that motivated the procedure. Methods: A retrospective study on 1,751 consecutive transplants (HLTx: 78) was performed from 1990 to 2020 in two centers. Overall survival, adjusted for clinical profile and etiological subgroups, was compared. 7 subgroups were considered: 1) Cardiomyopathy with pulmonary hypertension (CM + PH). 2) Eisenmenger syndrome. 3) Congenital heart disease (CHD). 4) Idiopathic pulmonary arterial hypertension (IPAH). 5) Cystic fibrosis. 6) Chronic obstructive pulmonary disease (COPD)/Emphysema. 7) Diffuse interstitial lung disease (ILD). Results: Early mortality was 44% and that of the rest of the follow-up was 31%. There were differences between HTLx and HTx in survival, also comparing groups with a similar clinical profile with propensity score (p= 0.04). Median survival was low in CM + PH (18 days), ILD (29 days) and CHD (114 days), intermediate in Eisenmenger syndrome (600 days), and longer in IPAH, COPD/Emphysema and cystic fibrosis. Conclusion: HLTx has a high mortality. The etiological analysis is of the utmost interest to make the most of the organs and improve survival.
RESUMO
Objetivo: Analizar los resultados obtenidos en cinco años deConsulta de Tabaquismo, valorando la abstinencia tabáquica al año de seguimiento de los fumadores que acudieron en fase de acción. Pacientes y métodos: Los fumadores proceden del Hospital Puerta de Hierro (trabajadores y pacientes) y del área sanitaria VI de Madrid. La consulta es individualizada y la metodología se ha ajustado a las recomendaciones del área de tabaquismo de la SEPAR, basadas en el tratamiento combinado de terapia farmacológica y apoyo psicológico verbal y reforzado con una guía práctica para dejar de fumar. La abstinencia anual se ha valorado en porcentajes absolutos y por el método de probabilidades de Kaplan-Meier, primero en todos los fumadores conjuntamente y segundo, en relación con la presencia o ausencia de: enfermedades relacionadas con el tabaquismo, diabetes y depresión. En este caso también se calculó el riesgo relativo de recaída (RR) y el intervalo de confianza del 95% (IC.95%). Se ha valorado en hombres y mujeres la ganancia de peso a los seis meses y al año de abstinencia. Resultados: El seguimiento se ha realizado en los 226 fumadores en fase de acción (46 % hombres, 54 % mujeres). Los tratamientos más utilizados fueron la terapia sustitutiva con nicotina (67%) y el bupropión (13%). Dejan de fumar un año el 31% (28,6% hombres y 32,2% mujeres). El 37% están abstinentes seis meses, el 48% tres meses, y el 72% un mes. La probabilidad de abstinencia por Kaplan-Meier es de 32%. El tratamiento que mejores resultados mostró fue la terapia sustitutiva con nicotina, tanto en forma de parches como asociada a chicles (35% de abstinencia anual). Los fumadores que tenían alguna patología asociada al tabaquismo eran 97. Su edad media, años de fumador e intentos previos de abandono eran significativamente mayores (*p<0,005) que de los 129 fumadores sin patología asociada. De los primeros dejan de fumar un año el 21% (probabilidad de abstinencia 23%) mientras que los que no tienen patología asociada dejan de fumar el 38% (probabilidad de abstinencia 38%). El riesgo de recaída es 1,6 veces superior en el grupo con patología asociada. Conclusiones: Nuestra consulta de tabaquismo consigue unas tasas de abandono de casi un tercio, que es bastante menor en los fumadores que tienen una patología asociada al tabaco. Estas tasas refuerzan la justificación de las consultas de tabaquismo como instrumento para facilitar la deshabituación tabáquica (AU)
Objective: Analyze the results obtained in 5 years of Smoking CessationConsultation, evaluating abstinence at 1 year of follow-up of the smokers who came in the action phase. Patients and methods: Those smokers who came from the hospital Puerta de Hierro (workers and patients) and from the health-care area VI of Madrid were included. The consultation was individualized and the method was adjusted to the SEPAR recommendations of the smoking cessation area, based on combined treatment of drug therapy and all psychological support and reinforced with a practical guide to quit smoking. Yearly abstinence was evaluated in absolute percentages and with the Kaplan-Meier likelihood method, first in all of the smokers jointly and then in relationship with the presence or absence of: diseases related with smoking, diabetes and depression. In this case, the relative risk of relapse (RR) and 95% confidence interval (95% CI) were also calculated. Weight gain at 6 months and 1 year of abstinence was also evaluated in men and women. Results: The follow-up was made in 226 smokers in the action phase(46% in men,54% women). The treatments used most were nicotine replacement therapy (67%) and Bupropion (13%). After 1 year, 31% (28.6% in men and 32.2% women) quit smoking. At 6 months, 37% were abstinent, at 3 months 48% and at 1 month 72%. The Kaplan Meier likelihood of abstinence is 32%. The treatment that had the best results was nicotine replacement therapy, both with patches and gum (35% of annual abstinence). There were 97 smokers who had a disease associated to smoking. Their main age, years of smoking and previous attempts to quit were significantly greater (*p < 0,005) then those of the 129 smokers with no associated disease. In the first group 21% quit smoking at 1 year (abstinence likelihood 23%) while 38% of those who had no associated disease quit smoking (abstinence likelihood 38%). Risk of relapse was 1.6 times greater in the group with associated disease. Conclusions: Our tobacco cessation clinic achieves cessation rates of almost one third, which is much less in the smokers who have any disease associated to tobacco. These rates reinforce the justification of smoking cessation consultation as an instrument to facilitate smoking cessation (AU)
