Department AIRMed and Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
Curr Opin Organ Transplant. 2010 Oct;15(5):558-62. doi: 10.1097/MOT.0b013e32833e1112.
Chronic allograft dysfunction continues to limit the enduring success of lung transplantation. Increasingly it is recognized that events very early post-transplant such as primary graft dysfunction can be linked to poor clinical outcomes at much later time points. In this article we review a number of the different processes that predispose the allograft to ischemia early post-transplant and explore how these events may contribute to obliterative bronchiolitis, the histological correlate of chronic lung allograft dysfunction.
Allograft ischemia may arise during explantation (warm ischemia), at implantation (in the absence of bronchial arterial reanastomosis) or at later time points (small airway microvascular damage). We describe how allograft ischemia may result in a hypoxic inflammatory milieu within the lung allograft that is conducive to vascular remodelling and angiogenesis.
Whilst the published literature for vascular remodelling in post-transplant obliterative bronchiolitis is not as extensive as that for asthma, a disease also characterized by airway pathology, there are clear parallels and shared pathophysiological pathways between the two diseases. An understanding of the complex interaction between ischemia, vascular remodelling and chronic lung allograft dysfunction may lead to the future development of therapeutic strategies that can unravel this association.
慢性移植物功能障碍仍然限制着肺移植的长期成功。越来越多的人认识到，移植后早期的原发性移植物功能障碍等事件与以后更久的时间点的不良临床结局有关。本文回顾了导致移植后早期移植物发生缺血的一些不同过程，并探讨了这些事件如何导致闭塞性细支气管炎，这是慢性肺移植物功能障碍的组织学相关性。
移植物缺血可能发生在切取（热缺血）、植入时（在没有支气管动脉再吻合的情况下）或以后的时间点（小气道微血管损伤）。我们描述了移植物缺血如何导致肺移植物内缺氧性炎症环境，有利于血管重塑和血管生成。
尽管移植后闭塞性细支气管炎的血管重塑文献不如哮喘（一种以气道病理学为特征的疾病）广泛，但这两种疾病之间存在明显的相似之处和共同的病理生理途径。了解缺血、血管重塑和慢性肺移植物功能障碍之间的复杂相互作用，可能会导致未来发展出能够解开这种关联的治疗策略。
