Snell Gregory I, Esmore Donald S, Westall Glen P, Marasco Silvana, Kotsimbos Tom, Pilcher David V, Myles Paul, Griffiths Anne, Levvey Bronwyn J, Williams Trevor J
Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Victoria, 3004, Australia.
Clin Transpl. 2007:131-44.
There has been considerable evolution in the pre-, peri- and postoperative management of patients with severe lung disease undergoing LTx. Compared with where we started at the Alfred Hospital in 1990, in 2008 we now recognize that the majority of donor lungs that are offered for LTx (including DCD lungs) are useable, patients with a wide range of ages and disease processes are suitable to be considered for LTx and modern surgical, anesthetic and ICU management should result in a 90% one-year survival rate. It is likely that the procedural mix in LTX servicing will remain little changed in the years to come, with BLTx being the pre-eminent service modality for the majority of end-stage lung disease patients. SLTx will remain a viable procedure almost exclusively for the IPF recipient, with HLTx a necessity for the congenital heart disease patient, for whom all other medical and surgical options have been exhausted. Notwithstanding theseconsiderable achievements, including the factthat one-third of patients now survive more than10 years, it is also apparent that BOS and recurrent infections remain a problem limiting the overall success of LTx. Understanding more about the interactions between the immunosuppressive regimen, infective agents (particularly viruses) and the recipients responses to all of the abovehold the keys to improving these late outcomes.
对于接受肺移植（LTx）的重症肺病患者，其术前、术中和术后管理已发生了显著演变。与1990年我们在阿尔弗雷德医院刚开始时相比，到2008年我们现在认识到，提供用于肺移植的大多数供体肺（包括心脏死亡后供体肺）都是可用的，各种年龄和疾病进程的患者都适合考虑进行肺移植，并且现代外科、麻醉和重症监护管理应能实现90%的一年生存率。在未来几年，肺移植服务中的手术组合可能变化不大，双肺移植（BLTx）仍是大多数终末期肺病患者的主要服务方式。单肺移植（SLTx）几乎仍将仅对特发性肺纤维化（IPF）受者是可行的手术，而心肺联合移植（HLTx）对于先天性心脏病患者是必要的，因为对这些患者而言所有其他医疗和手术选择都已用尽。尽管取得了这些显著成就，包括现在三分之一的患者存活超过10年这一事实，但显然闭塞性细支气管炎（BOS）和反复感染仍然是限制肺移植总体成功率的问题。更多地了解免疫抑制方案、感染因子（特别是病毒）与受者对上述所有因素的反应之间的相互作用是改善这些晚期结果的关键。
