Knoop C, Rondelet B, Dumonceaux M, Estenne M
Unité de transplantation cardiaque et pulmonaire (UTCP), service de pneumologie, hôpital universitaire Érasme, Bruxelles, Belgique.
Rev Pneumol Clin. 2010 Feb;67(1):28-49. doi: 10.1016/j.pneumo.2010.08.002. Epub 2011 Feb 2.
In 2010, lung transplantation is a valuable therapeutic option for a number of patients suffering from of end-stage non-neoplastic pulmonary diseases. The patients frequently regain a very good quality of life, however, long-term survival is often hampered by the development of complications such as the bronchiolitis obliterans syndrome, metabolic and infectious complications. As the bronchiolitis obliterans syndrome is the first cause of death in the medium and long term, an intense immunosuppressive treatment is maintained for life in order to prevent or stabilize this complication. The immunosuppression on the other hand induces a number of potentially severe complications including metabolic complications, infections and malignancies. The most frequent metabolic complications are arterial hypertension, chronic renal insufficiency, diabetes, hyperlipidemia and osteoporosis. Bacterial, viral and fungal infections are the second cause of mortality. They are to be considered as medical emergencies and require urgent assessment and targeted therapy after microbiologic specimens have been obtained. They should not, under any circumstances, be treated empirically and it has also to be kept in mind that the lung transplant recipient may present several concomitant infections. The most frequent malignancies are skin cancers, the post-transplant lymphoproliferative disorders, Kaposi's sarcoma and some types of bronchogenic carcinomas, head/neck and digestive cancers. Lung transplantation is no longer an exceptional procedure; thus, the pulmonologist will be confronted with such patients and should be able to recognize the symptoms and signs of the principal non-surgical complications. The goal of this review is to give a general overview of the most frequently encountered complications. Their assessment and treatment, though, will most often require the input of other specialists and a multidisciplinary and transversal approach.
2010年，肺移植对于许多终末期非肿瘤性肺部疾病患者而言是一种有价值的治疗选择。患者通常能恢复非常好的生活质量，然而，长期生存常常受到诸如闭塞性细支气管炎综合征、代谢及感染性并发症等并发症的影响。由于闭塞性细支气管炎综合征是中长期死亡的首要原因，因此需终身维持强化免疫抑制治疗以预防或稳定该并发症。另一方面，免疫抑制会引发一系列潜在的严重并发症，包括代谢并发症、感染及恶性肿瘤。最常见的代谢并发症有动脉高血压、慢性肾功能不全、糖尿病、高脂血症及骨质疏松。细菌、病毒及真菌感染是第二大死亡原因。它们应被视为医疗急症，在获取微生物标本后需要紧急评估及针对性治疗。在任何情况下都不应进行经验性治疗，同时还需牢记肺移植受者可能存在多种合并感染。最常见的恶性肿瘤有皮肤癌、移植后淋巴细胞增生性疾病、卡波西肉瘤以及某些类型的支气管源性癌、头颈部癌和消化道癌。肺移植已不再是一种罕见的手术；因此，肺科医生将会面对此类患者，并且应该能够识别主要非手术并发症的症状和体征。本综述的目的是对最常遇到的并发症进行总体概述。不过，对它们的评估和治疗通常需要其他专科医生的参与以及多学科和横向的方法。
