附錄 C — 附錄 C. 國際比較快速參考 / Appendix C. International Comparison Quick Reference
參考： wiki/ 各中心文章, data/ CSV 資料集 版本： v1.2
References: wiki/ center articles, data/ CSV datasets Version: v1.2
C.1 C.1 四大中心比較總表 / C.1 Four Major Centers Comparison Summary
| 項目 | 維也納 AKH | 東京大學 UTokyo | 魯汶 KU Leuven | 三總 TSGH |
|---|---|---|---|---|
| 年案量 | ~170（2023-2024）[Vienna-Aigner-2025] | ~25（2024: 日本全國 148 例） | ~80 | 📋 待補 |
| 累積案量 | 2,672（1989-2024）[Vienna-Aigner-2025] | 256（至 2025 年 8 月） | >900 | 📋 待補 |
| 術中 ECMO | 全部（routine VA） | 選擇性（CPB/ECMO） | 選擇性 | ⚠️ 待定 |
| Induction | ATG / Basiliximab（selected） | 不常規使用 | Basiliximab | ⚠️ 待定 |
| CNI | Tacrolimus | Tacrolimus | Tacrolimus | Tacrolimus |
| Tac 起始 | Oral | IV 0.03 mg/kg/h x 10d | Oral | ⚠️ 待定 |
| Steroid（術中） | 1000 mg | 500 mg | 500 mg | ⚠️ 待定 |
| Steroid 維持 | 5 mg/day | 5 mg/day | 5 mg/day | 5 mg/day |
| PGD3 @ 72h | 1.3% | — | ~5% | 📋 待補 |
| 1-year survival | 85%（2019-2024）[Vienna-Aigner-2025] | ~80% | ~90% | 📋 待補 |
| 5-year survival | 73%（2019-2024）[Vienna-Aigner-2025] | ~65% | ~70% | 📋 待補 |
| Surveillance TBBx | 常規 | 不常規 | 常規 | ⚠️ 待定 |
| Item | Vienna AKH | UTokyo | KU Leuven | TSGH | |—|—|—|—|—| | Annual volume | ~170 (2023-2024) [Vienna-Aigner-2025] | ~25 (2024: nationwide Japan 148 cases) | ~80 | 📋 TBD | | Cumulative volume | 2,672 (1989-2024) [Vienna-Aigner-2025] | 256 (through August 2025) | >900 | 📋 TBD | | Intraoperative ECMO | All (routine VA) | Selective (CPB/ECMO) | Selective | ⚠️ TBD | | Induction | ATG / Basiliximab (selected) | Not routine | Basiliximab | ⚠️ TBD | | CNI | Tacrolimus | Tacrolimus | Tacrolimus | Tacrolimus | | Tac initiation | Oral | IV 0.03 mg/kg/h x 10d | Oral | ⚠️ TBD | | Steroid (intraoperative) | 1000 mg | 500 mg | 500 mg | ⚠️ TBD | | Steroid maintenance | 5 mg/day | 5 mg/day | 5 mg/day | 5 mg/day | | PGD3 @ 72h | 1.3% | — | ~5% | 📋 TBD | | 1-year survival | 85% (2019-2024) [Vienna-Aigner-2025] | ~80% | ~90% | 📋 TBD | | 5-year survival | 73% (2019-2024) [Vienna-Aigner-2025] | ~65% | ~70% | 📋 TBD | | Surveillance TBBx | Routine | Not routine | Routine | ⚠️ TBD |
C.2 C.2 器官摘取比較 / C.2 Organ Procurement Comparison
| 項目 | 維也納 | UTokyo | 魯汶 | 三總 |
|---|---|---|---|---|
| 保存液 | Perfadex | Perfadex | Perfadex | ⚠️ |
| 灌流溫度 | 10°C（optimal） | Cold | Cold | ⚠️ |
| Retrograde flush | ✅ | ✅ | ✅ | ⚠️ |
| 保存充氣 | 50% O₂ | — | — | ⚠️ |
| Ex-vivo 灌流 | EVLP（研究中） | EVLP（研究中） | EVLP（研究中） | OCS Lung ✅（台灣首家） |
| Item | Vienna | UTokyo | Leuven | TSGH | |—|—|—|—|—| | Preservation solution | Perfadex | Perfadex | Perfadex | ⚠️ | | Perfusion temperature | 10°C (optimal) | Cold | Cold | ⚠️ | | Retrograde flush | ✅ | ✅ | ✅ | ⚠️ | | Inflation preservation | 50% O₂ | — | — | ⚠️ | | Ex-vivo perfusion | EVLP (research) | EVLP (research) | EVLP (research) | OCS Lung ✅ (first in Taiwan) |
C.3 C.3 ECMO 策略比較 / C.3 ECMO Strategy Comparison
| 項目 | 維也納 | UTokyo | 魯汶 |
|---|---|---|---|
| 術中 ECMO | All BLTx（routine） | Selective | Selective |
| 模式 | Central VA-ECMO | CPB 或 VA-ECMO | CPB 或 VA-ECMO |
| Flow | 40-50% CO | Full support | Variable |
| Prolongation criteria | P/F <100, mPAP/mABP >2/3 | Case-by-case | Case-by-case |
| Prolongation rate | 77% | Low | Low |
| Mean prolongation | 30±12 hours | — | — |
| Anticoagulation | Enoxaparin 0.5 mg/kg BID | UFH | Variable |
| Item | Vienna | UTokyo | Leuven | |—|—|—|—| | Intraoperative ECMO | All BLTx (routine) | Selective | Selective | | Mode | Central VA-ECMO | CPB or VA-ECMO | CPB or VA-ECMO | | Flow | 40-50% CO | Full support | Variable | | Prolongation criteria | P/F <100, mPAP/mABP >2/3 | Case-by-case | Case-by-case | | Prolongation rate | 77% | Low | Low | | Mean prolongation | 30±12 hours | — | — | | Anticoagulation | Enoxaparin 0.5 mg/kg BID | UFH | Variable |
C.4 C.4 免疫抑制比較 / C.4 Immunosuppression Comparison
C.4.1 Induction / Induction
| 中心 | 藥物 | 備註 |
|---|---|---|
| 維也納 | ATG / Basiliximab | Selected patients |
| UTokyo | 無 | 不常規使用 |
| Toronto | 無 | 不常規使用 |
| 魯汶 | Basiliximab | 常規 |
| BWH | Basiliximab | 常規 |
| UNC | ATG | 常規 |
| Center | Drug | Notes | |—|—|—| | Vienna | ATG / Basiliximab | Selected patients | | UTokyo | None | Not routine | | Toronto | None | Not routine | | Leuven | Basiliximab | Routine | | BWH | Basiliximab | Routine | | UNC | ATG | Routine |
C.4.2 Tacrolimus 目標（0-3 個月） / Tacrolimus Target (0-3 months)
| 中心 | Trough 目標 |
|---|---|
| UTokyo | 15-20 ng/mL（IV 期） → 9-12（oral 期） |
| 維也納 | 10-15 ng/mL |
| 魯汶 | 10-15 ng/mL |
| BWH | 10-12 ng/mL |
| UNC | 8-12 ng/mL |
| Center | Trough Target | |—|—| | UTokyo | 15-20 ng/mL (IV phase) → 9-12 (oral phase) | | Vienna | 10-15 ng/mL | | Leuven | 10-15 ng/mL | | BWH | 10-12 ng/mL | | UNC | 8-12 ng/mL |
C.5 C.5 感染預防比較 / C.5 Infection Prevention Comparison
| 項目 | 維也納 | UTokyo | BWH | UNC |
|---|---|---|---|---|
| CMV 預防 | Valganciclovir 6-12m | Ganciclovir IV → Valganciclovir | Valganciclovir 6-12m | Valganciclovir 12m |
| PCP 預防 | TMP-SMX（終生） | TMP-SMX（終生） | TMP-SMX（終生） | TMP-SMX（終生） |
| 黴菌預防 | 吸入性 Amphotericin | Itraconazole | 吸入性 Amphotericin | Voriconazole |
| Item | Vienna | UTokyo | BWH | UNC | |—|—|—|—|—| | CMV prevention | Valganciclovir 6-12m | Ganciclovir IV → Valganciclovir | Valganciclovir 6-12m | Valganciclovir 12m | | PCP prevention | TMP-SMX (lifelong) | TMP-SMX (lifelong) | TMP-SMX (lifelong) | TMP-SMX (lifelong) | | Fungal prevention | Inhaled Amphotericin | Itraconazole | Inhaled Amphotericin | Voriconazole |
C.6 C.6 全球統計快覽（data/ CSV 完整資料） / C.6 Global Statistics Quick Overview (full data in data/ CSV)
C.6.1 C.6.1 全球 21 國肺移植統計（2024 年） / C.6.1 Global Lung Transplant Statistics Across 21 Countries (2024)
資料來源：IRODaT 2024, Eurotransplant 2024, 各國移植組織
Data sources: IRODaT 2024, Eurotransplant 2024, respective national transplant organizations
| 排名 | 國家 | 年案量 | pmp | 總屍體捐贈者 | DCD 捐贈者 | 分配組織 |
|---|---|---|---|---|---|---|
| 1 | 美國 | 3,340 | 9.05 | 16,336 | 5,895 | UNOS/OPTN |
| 2 | 西班牙 | 623 | 13.11 | 2,278 | 1,149 | ONT |
| 3 | 加拿大 | 416 | 10.64 | 894 | 321 | CBS |
| 4 | 法國 | 332 | 5.12 | 1,856 | 312 | ABM |
| 5 | 德國 | 311 | 3.73 | 953 | 0 | Eurotransplant |
| 6 | 印度 | 228 | 0.16 | 1,128 | 2 | NOTTO |
| 7 | 韓國 | 185 | 3.75 | 397 | — | KONOS |
| 8 | 義大利 | 174 | 2.96 | 1,795 | 306 | CNT |
| 9 | 日本 | 148 | 1.21 | 138 | 8 | JOT |
| 10 | 澳洲 | 137 | 5.13 | 527 | 192 | DonateLife |
| 11 | 英國 | 130 | 1.91 | 1,385 | 686 | NHSBT |
| 12 | 荷蘭 | 123 | 6.95 | 373 | 247 | Eurotransplant |
| 13 | 比利時 | 108 | — | — | — | Eurotransplant |
| 14 | 奧地利 | 106 | 11.78 | 166 | 30 | Eurotransplant |
| 15 | 巴西 | 93 | 0.43 | 3,711 | 0 | SNT |
| 16 | 瑞士 | 63 | 7.08 | 187 | 98 | Swisstransplant |
| 17 | 瑞典 | 58 | 5.42 | 243 | 60 | Scandiatransplant |
| 18 | 台灣 | 20-30 | ~1.0 | — | — | TORSC |
| 19 | 匈牙利 | 18 | — | — | — | Eurotransplant |
| 20 | 斯洛維尼亞 | 11 | — | — | — | Eurotransplant |
| 21 | 克羅埃西亞 | 6 | — | — | — | Eurotransplant |
| Rank | Country | Annual Volume | pmp | Total Deceased Donors | DCD Donors | Allocation Organization | |—|—|—|—|—|—|—| | 1 | United States | 3,340 | 9.05 | 16,336 | 5,895 | UNOS/OPTN | | 2 | Spain | 623 | 13.11 | 2,278 | 1,149 | ONT | | 3 | Canada | 416 | 10.64 | 894 | 321 | CBS | | 4 | France | 332 | 5.12 | 1,856 | 312 | ABM | | 5 | Germany | 311 | 3.73 | 953 | 0 | Eurotransplant | | 6 | India | 228 | 0.16 | 1,128 | 2 | NOTTO | | 7 | South Korea | 185 | 3.75 | 397 | — | KONOS | | 8 | Italy | 174 | 2.96 | 1,795 | 306 | CNT | | 9 | Japan | 148 | 1.21 | 138 | 8 | JOT | | 10 | Australia | 137 | 5.13 | 527 | 192 | DonateLife | | 11 | United Kingdom | 130 | 1.91 | 1,385 | 686 | NHSBT | | 12 | Netherlands | 123 | 6.95 | 373 | 247 | Eurotransplant | | 13 | Belgium | 108 | — | — | — | Eurotransplant | | 14 | Austria | 106 | 11.78 | 166 | 30 | Eurotransplant | | 15 | Brazil | 93 | 0.43 | 3,711 | 0 | SNT | | 16 | Switzerland | 63 | 7.08 | 187 | 98 | Swisstransplant | | 17 | Sweden | 58 | 5.42 | 243 | 60 | Scandiatransplant | | 18 | Taiwan | 20-30 | ~1.0 | — | — | TORSC | | 19 | Hungary | 18 | — | — | — | Eurotransplant | | 20 | Slovenia | 11 | — | — | — | Eurotransplant | | 21 | Croatia | 6 | — | — | — | Eurotransplant |
台灣 pmp ~1.0，與日本（1.21）相近，遠低於西班牙（13.11）和美國（9.05）。提升器捐率是擴大肺移植的關鍵。 西班牙 pmp 最高（13.11），歸功於 ONT 三級協調師制度。 日本 pmp 僅 1.21（全球最低之一），受限於腦死判定法規。
Taiwan pmp ~1.0, similar to Japan (1.21), far below Spain (13.11) and the United States (9.05). Improving organ donation rates is key to expanding lung transplantation. Spain has the highest pmp (13.11), attributed to the ONT three-tier coordinator system. Japan pmp only 1.21 (among the lowest globally), limited by brain death determination regulations.
C.6.2 C.6.2 美國 Top 21 肺移植中心 / C.6.2 Top 21 US Lung Transplant Centers
資料來源：SRTR, OPTN, 各中心公告 2024-2025
Data sources: SRTR, OPTN, center announcements 2024-2025
| 中心 | 城市 | 年案量 | SRTR Tier | 特色 |
|---|---|---|---|---|
| Cleveland Clinic | Cleveland, OH | ~451 | — | 美國累積最多（>2,500） |
| Stanford Hospital | Palo Alto, CA | ~295 | — | 心肺移植先驅（Shumway） |
| UT Southwestern | Dallas, TX | ~227 | — | 德州最大 |
| Vanderbilt | Nashville, TN | 149 | — | Hoetzenecker（Vienna 出身）任手術主任 |
| Northwestern | Chicago, IL | 148 | — | Bharat; OCS/robotic LTx; COVID 先驅; 中位等待 4 天 |
| UPMC | Pittsburgh, PA | ~110 | — | SRTR 高存活 |
| Norton Thoracic | Phoenix, AZ | 103 | Tier 5 | 西部最大 |
| UCSF | San Francisco, CA | 100+ | — | 連續 13 年顯著優於預期; 1 年存活 95% |
| Toronto General | Toronto, Canada | 100+ | — | 世界首例成功 LTx（1983）; EVLP 先驅; >1000 EVLP |
| UCLA | Los Angeles, CA | 95 | Tier 4 | 西岸主要中心 |
| Cedars-Sinai | Los Angeles, CA | 88 | — | LA 主要中心 |
| NYU Langone | New York, NY | ~80 | Tier 4 | SRTR 全美最高品質評級 |
| Mayo - Jacksonville | Jacksonville, FL | 74 | Tier 5 | Mayo Florida |
| UF Health Shands | Gainesville, FL | 67 | Tier 5 | |
| Corewell Health | Grand Rapids, MI | 55 | Tier 5 | |
| Duke | Durham, NC | — | — | 全美最短等待時間; 主要研究中心 |
| Mayo - Rochester | Rochester, MN | — | — | Mayo 總院 |
| U of Michigan | Ann Arbor, MI | — | — | 主要學術中心 |
| IU Health Methodist | Indianapolis, IN | 39 | Tier 5 | |
| U of Alabama | Birmingham, AL | 26 | Tier 4 | |
| U of Iowa | Iowa City, IA | 15 | Tier 5 |
| Center | City | Annual Volume | SRTR Tier | Distinguishing Features | |—|—|—|—|—| | Cleveland Clinic | Cleveland, OH | ~451 | — | Highest cumulative in the US (>2,500) | | Stanford Hospital | Palo Alto, CA | ~295 | — | Heart-lung transplant pioneer (Shumway) | | UT Southwestern | Dallas, TX | ~227 | — | Largest in Texas | | Vanderbilt | Nashville, TN | 149 | — | Hoetzenecker (Vienna-trained) as surgical director | | Northwestern | Chicago, IL | 148 | — | Bharat; OCS/robotic LTx; COVID pioneer; median wait 4 days | | UPMC | Pittsburgh, PA | ~110 | — | SRTR high survival | | Norton Thoracic | Phoenix, AZ | 103 | Tier 5 | Largest in western US | | UCSF | San Francisco, CA | 100+ | — | 13 consecutive years significantly better than expected; 1-year survival 95% | | Toronto General | Toronto, Canada | 100+ | — | World’s first successful LTx (1983); EVLP pioneer; >1000 EVLP | | UCLA | Los Angeles, CA | 95 | Tier 4 | Major west coast center | | Cedars-Sinai | Los Angeles, CA | 88 | — | Major LA center | | NYU Langone | New York, NY | ~80 | Tier 4 | SRTR highest quality rating nationwide | | Mayo - Jacksonville | Jacksonville, FL | 74 | Tier 5 | Mayo Florida | | UF Health Shands | Gainesville, FL | 67 | Tier 5 | | | Corewell Health | Grand Rapids, MI | 55 | Tier 5 | | | Duke | Durham, NC | — | — | Shortest wait time nationwide; major research center | | Mayo - Rochester | Rochester, MN | — | — | Mayo main campus | | U of Michigan | Ann Arbor, MI | — | — | Major academic center | | IU Health Methodist | Indianapolis, IN | 39 | Tier 5 | | | U of Alabama | Birmingham, AL | 26 | Tier 4 | | | U of Iowa | Iowa City, IA | 15 | Tier 5 | |
C.6.3 C.6.3 歐洲主要肺移植中心 / C.6.3 Major European Lung Transplant Centers
資料來源：Eurotransplant, NHSBT, Council of Europe 2024
Data sources: Eurotransplant, NHSBT, Council of Europe 2024
| 中心 | 城市/國家 | 年案量 | 分配系統 | 特色 |
|---|---|---|---|---|
| Vienna AKH | 維也納/奧地利 | ~170 | Eurotransplant | 歐洲最大; routine ECMO; 8 國 hub |
| Hannover MHH | 漢諾威/德國 | 103-110 | Eurotransplant | Eurotransplant 最高量; 保存先驅 |
| KU Leuven | 魯汶/比利時 | ~80 | Eurotransplant | LUNGguard; EVLP RCT |
| Royal Papworth | 劍橋/英國 | 40-50 | NHSBT | 歐洲最高存活率; EVLP |
| Pitié-Salpêtrière | 巴黎/法國 | — | ABM | 法國最大 |
| Henri-Mondor | 克雷泰伊/法國 | — | ABM | 法國主要 |
| UH Zurich | 蘇黎世/瑞士 | — | Swisstransplant | EVLP 多中心 RCT |
| Sahlgrenska | 哥德堡/瑞典 | — | Scandiatransplant | 北歐最大 |
| Puerta de Hierro | 馬德里/西班牙 | — | ONT | 西班牙主要; EVLP |
| Policlinico Milano | 米蘭/義大利 | — | CNT |
| Center | City/Country | Annual Volume | Allocation System | Distinguishing Features | |—|—|—|—|—| | Vienna AKH | Vienna/Austria | ~170 | Eurotransplant | Largest in Europe; routine ECMO; 8-country hub | | Hannover MHH | Hannover/Germany | 103-110 | Eurotransplant | Highest Eurotransplant volume; preservation pioneer | | KU Leuven | Leuven/Belgium | ~80 | Eurotransplant | LUNGguard; EVLP RCT | | Royal Papworth | Cambridge/UK | 40-50 | NHSBT | Highest survival in Europe; EVLP | | Pitie-Salpetriere | Paris/France | — | ABM | Largest in France | | Henri-Mondor | Creteil/France | — | ABM | Major French center | | UH Zurich | Zurich/Switzerland | — | Swisstransplant | Multicenter EVLP RCT | | Sahlgrenska | Gothenburg/Sweden | — | Scandiatransplant | Largest in Scandinavia | | Puerta de Hierro | Madrid/Spain | — | ONT | Major Spanish center; EVLP | | Policlinico Milano | Milan/Italy | — | CNT | |
C.6.4 C.6.4 亞洲肺移植中心 / C.6.4 Asian Lung Transplant Centers
資料來源：JOT, TORSC, KONOS, 各中心發表
Data sources: JOT, TORSC, KONOS, center publications
日本（9 個認證中心，2024 全國 148 例）：
Japan (9 certified centers, 148 nationwide cases in 2024):
| 中心 | 城市 | 累積案量 | 特色 |
|---|---|---|---|
| 京都大學 | 京都 | 368 | 日本累積最多; Date 教授活體移植先驅 |
| 東京大學 | 東京 | 256 | Sato lab; 活體+VATS; 2014 年起 |
| 岡山大學 | 岡山 | — | 1998 世界首例活體肺葉移植 |
| 東北大學 | 仙台 | — | 認證中心 |
| 獨協醫大 | 栃木 | — | 認證中心 |
| 千葉大學 | 千葉 | — | 認證中心 |
| 大阪大學 | 大阪 | — | 認證中心 |
| 福岡大學 | 福岡 | — | 認證中心 |
| 長崎大學 | 長崎 | — | 認證中心 |
| Center | City | Cumulative Volume | Distinguishing Features | |—|—|—|—| | Kyoto University | Kyoto | 368 | Highest cumulative in Japan; Prof. Date pioneered living-donor transplant | | University of Tokyo | Tokyo | 256 | Sato lab; living-donor + VATS; since 2014 | | Okayama University | Okayama | — | World’s first living-donor lobar transplant (1998) | | Tohoku University | Sendai | — | Certified center | | Dokkyo Medical University | Tochigi | — | Certified center | | Chiba University | Chiba | — | Certified center | | Osaka University | Osaka | — | Certified center | | Fukuoka University | Fukuoka | — | Certified center | | Nagasaki University | Nagasaki | — | Certified center |
台灣（6 個認證中心）：
Taiwan (6 certified centers):
| 中心 | 城市 | 特色 |
|---|---|---|
| 台大醫院（NTUH） | 台北 | 台灣最大; 亞洲首例 SLTx/BLTx; 3 年存活 ~51% |
| 長庚醫院林口 | 桃園 | 台灣第二大; 2019 起 >20/年 |
| 三軍總醫院（TSGH） | 台北 | OCS Lung 台灣首家; 完整 SOP; 軍醫院 |
| 中國醫藥大學附醫 | 台中 | 建置中; fellow 受訓於 Vienna（陳建勳） |
| 亞東醫院 | 新北 | 認證中心 |
| 成大醫院 | 台南 | 認證中心 |
| Center | City | Distinguishing Features | |—|—|—| | National Taiwan University Hospital (NTUH) | Taipei | Largest in Taiwan; first SLTx/BLTx in Asia; 3-year survival ~51% | | Chang Gung Memorial Hospital, Linkou | Taoyuan | Second largest in Taiwan; >20/year since 2019 | | Tri-Service General Hospital (TSGH) | Taipei | First OCS Lung in Taiwan; comprehensive SOP; military medical center | | China Medical University Hospital | Taichung | Under development; fellow trained in Vienna (Dr. Chen Chien-Hsun) | | Far Eastern Memorial Hospital | New Taipei City | Certified center | | National Cheng Kung University Hospital | Tainan | Certified center |
韓國（主要 3 中心，2024 全國 185 例）：
South Korea (3 major centers, 185 nationwide cases in 2024):
| 中心 | 城市 | 特色 |
|---|---|---|
| Asan Medical Center | 首爾 | 韓國主要移植中心 |
| Samsung Medical Center | 首爾 | 韓國主要 |
| Severance Hospital（延世大學） | 首爾 | 韓國主要 |
| Center | City | Distinguishing Features | |—|—|—| | Asan Medical Center | Seoul | Major Korean transplant center | | Samsung Medical Center | Seoul | Major Korean center | | Severance Hospital (Yonsei University) | Seoul | Major Korean center |
其他亞太：
Other Asia-Pacific:
| 中心 | 國家 | 年案量 |
|---|---|---|
| NUH | 新加坡 | 20-40 |
| Center | Country | Annual Volume | |—|—|—| | NUH | Singapore | 20-40 |
📋 台灣各中心年案量需自衛福部器捐登錄中心取得
📋 Annual volumes for each Taiwan center need to be obtained from the Ministry of Health and Welfare Organ Donation Registry Center
C.7 C.7 決策快速參考 / C.7 Decision Quick Reference
C.7.1 「三總該怎麼做？」決策輔助 / “What Should TSGH Do?” Decision Aid
| 議題 | 建議考量 |
|---|---|
| 術中 ECMO | Vienna routine VA 結果最佳（PGD3 1.3%），但需團隊經驗與設備 |
| Induction | 日本/Toronto 不用也有不錯成果，但多數西方中心傾向使用 |
| Surveillance TBBx | UTokyo 不做也可行（以臨床 + 影像判斷），各有利弊 |
| Tac 起始 | UTokyo IV start 可提供穩定 level，但需 ICU 監測 |
| CMV 預防時長 | D+/R- 至少 12 個月；其他 6-12 個月 |
| 體外灌流 | 三總已有 OCS Lung，需建立啟動標準與操作 SOP |
| Issue | Considerations | |—|—| | Intraoperative ECMO | Vienna routine VA yields best results (PGD3 1.3%), but requires team experience and equipment | | Induction | Japan/Toronto achieve good outcomes without induction, but most Western centers favor its use | | Surveillance TBBx | UTokyo approach without TBBx is feasible (clinical + imaging assessment), with pros and cons | | Tac initiation | UTokyo IV start provides stable levels but requires ICU monitoring | | CMV prophylaxis duration | D+/R- at least 12 months; others 6-12 months | | Ex-vivo perfusion | TSGH already has OCS Lung; initiation criteria and operational SOP need to be established |
⚠️ 所有決策需由臨床團隊根據三總實際條件與經驗做最終判斷。
⚠️ All decisions require final determination by the clinical team based on TSGH’s actual conditions and experience.
C.8 C.8 中心最新動態（v1.2 更新） / C.8 Latest Center Updates (v1.2 Update)
C.8.1 Vienna AKH 更新 [Vienna-Aigner-2025] / Vienna AKH Update [Vienna-Aigner-2025]
| 項目 | 數據 |
|---|---|
| 2024 轉介量 | 302 位患者，中位年齡 60.4 歲 |
| 手術切口轉變 | Thoracotomy 66.5% vs Clamshell 33.5%（n=170）；傷口感染率 9.7% vs 22.8%（p=0.031） |
| 中位通氣時間 | 1-2 天（2021-2023 年） |
| 中位 ICU 住院 | 7 天（2021-2023 年） |
| ECP 預防排斥 | 前瞻性 RCT 顯示 ECP 可降低 ACR 及 DSA 形成（Alemanno et al., 2025） |
| 10°C 保存技術 | 多中心 RCT 進行中（Vienna、Toronto、Duke 等） |
| 新興方向 | LifeLUNG 保存平台、AI 輔助 EVLP 評估、異種移植研究、MIS/機器人輔助探索 |
| Item | Data | |—|—| | 2024 referral volume | 302 patients, median age 60.4 years | | Surgical approach shift | Thoracotomy 66.5% vs Clamshell 33.5% (n=170); wound infection rate 9.7% vs 22.8% (p=0.031) | | Median ventilation time | 1-2 days (2021-2023) | | Median ICU stay | 7 days (2021-2023) | | ECP for rejection prevention | Prospective RCT showed ECP reduces ACR and DSA formation (Alemanno et al., 2025) | | 10°C preservation technique | Multicenter RCT underway (Vienna, Toronto, Duke, etc.) | | Emerging directions | LifeLUNG preservation platform, AI-assisted EVLP assessment, xenotransplantation research, MIS/robotic-assisted exploration |
C.8.2 UTokyo 更新 / UTokyo Update
| 項目 | 數據 |
|---|---|
| 日本 2024 年案量 | 全國 148 例（首次突破 100） |
| 活體捐贈比例 | 23.7%（約 24 例雙側活體） |
| 中位等待時間 | 930 天（約 2.5 年） |
| 等候名單死亡率 | 40% |
| 供體利用率 | 約 15% |
| 分配制度 | 先到先得（First come, first serve） |
| 特殊禁忌 | HTLV-1 感染（日本風土病）、vCJD |
| Item | Data | |—|—| | Japan 2024 annual volume | 148 nationwide cases (first time exceeding 100) | | Living-donor proportion | 23.7% (approximately 24 bilateral living-donor cases) | | Median wait time | 930 days (approximately 2.5 years) | | Waitlist mortality | 40% | | Donor utilization rate | Approximately 15% | | Allocation system | First come, first serve | | Unique contraindications | HTLV-1 infection (endemic in Japan), vCJD |
C.9 參考文獻 / References
- wiki/ 全部中心文章
- data/ 全球中心 CSV 資料集
- ISHLT Registry Reports
- SRTR Annual Data Reports
- 各中心發表文獻
1. wiki/ all center articles 2. data/ global center CSV datasets 3. ISHLT Registry Reports 4. SRTR Annual Data Reports 5. Center-specific publications