目的 总结分析1例心肺移植患者术后5年随访时移植物功能变化及影响长期存活的关键因素。方法 2003年12月复旦大学中山医院为1例房间隔缺损并重度肺动脉高压心肺功能衰竭的患者施行心肺联合移植术。供体心肺以1 000 mL UW液及4 000 mL HTK液保存。术后抗排异治疗方案采用达昔单抗、环孢霉素A（或他克莫司）、霉酚酸酯及激素四联方案,环孢霉素A谷浓度维持在100~200 μg/L，他克莫司谷浓度维持在8~20 μg/L。术后定期复查超声心动图、肺功能及胸部CT评估心肺功能。结果 随访时患者存活已达5年6个月。心功能恢复为（NYHA）Ⅰ~Ⅱ级，左心室射血分数65%~86%。肺功能检查氧和指标稳定，术后1年开始出现小气道气流受阻表现但保持稳定。随访中出现2次严重肺部感染，经联合应用抗细菌及真菌药物治愈，无急性排斥反应事件发生。结论 心肺联合移植是治疗心肺功能衰竭的有效方法，良好的供体保护、准确平衡抗排斥反应与感染的关系，以及严格预防和治疗感染是患者长期存活的关键因素。

Objective To evaluate the cardiopulmonary allograft function and to analyze key factors for long-term survival of heart-lung transplantation in a patient survived more than 5 years. Methods On December 17^th, 2003 at Zhongshan Hospital of Fudan University, a homologous heart-lung transplantation was performed on a female who diagnosed with cardiopulmonary failure secondary to congenital atrial septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1 000 mL UW solution and 4 000 mL HTK solution. Postoperative immunosuppressive therapies were managed with Zenapax, cyclosporine A (or tacrolimus), mycophenolate mofetil and corticosteroids. Cyclosporine A maintained with serum trough levels of 100-200 μg/L and tacrolimus with serum trough levels of 8-20 μg/L. Cardiopulmonary allograft functions were evaluated by echocardiogram, pulmonary function test and thoracic CT periodically. Results The patient survived operation and experienced normal daily life with NYHA cardiac function of class Ⅰ-Ⅱ during the follow-up of 5 years and 6 months. Echocardiogram showed left ventricular ejection fraction of 65% to 86%. Pulmonary function test exhibited with nearly normal oxygen exchange, meanwhile, small airway obstruction was detected from one year after operation and keeping stable from then on. Two episodes of severe pneumonia were complicated and treated with antibiotics and fhconazob, no severe acute allograft rejection episode was experienced. Conclusions Heart-lung transplantation proves to be a reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation, accurate balance of the risk between acute allograft rejection and infection, and strict preventive measures against infection are key factors for long-term survival of heart-lung transplantation.