Service de Chirurgie Thoracique et Vasculaire, CHUV, Lausanne, Switzerland.
Swiss Med Wkly. 2011 Nov 8;141:w13292. doi: 10.4414/smw.2011.13292. eCollection 2011.
Lung transplantation is an established therapy for end-stage pulmonary disorders in selected patients without significant comorbidities. The particular constraints associated with organ transplantation from deceased donors involve specific allocation rules in order to optimise the medical efficacy of the procedure. Comparison of different policies adopted by national transplant agencies reveals that an optimal and unique allocation system is an elusive goal, and that practical, geographical and logistic parameters must be taken into account. A solution to attenuate the imbalance between the number of lung transplant candidates and the limited availability of organs is to consider marginal donors. In particular, assessment and restoration of gas exchange capacity ex vivo in explanted lungs is a new and promising approach that some lung transplant programmes have started to apply in clinical practice. Chronic lung allograft dysfunction, and especially bronchiolitis obliterans, remains the major medium- and long-term problem in lung transplantation with a major impact on survival. Although there is to date no cure for established bronchiolitis obliterans, new preventive strategies have the potential to limit the burden of this feared complication. Unfortunately, randomised prospective studies are infrequent in the field of lung transplantation, and data obtained from larger studies involving kidney or liver recipients are not always relevant for this purpose.
肺移植是治疗特定无重大合并症的晚期肺部疾病的一种既定疗法。从已故供体进行器官移植所涉及的特定限制涉及特定的分配规则，以优化该程序的医疗效果。比较不同国家移植机构采用的不同政策表明，找到一个最佳且独特的分配系统是一个难以实现的目标，并且必须考虑实际、地理和后勤参数。缓解肺移植候选者数量与器官有限可用性之间不平衡的一种解决方案是考虑边缘供体。特别是，在离体肺中评估和恢复气体交换能力是一种新的有前途的方法，一些肺移植计划已开始在临床实践中应用。慢性肺移植物功能障碍，特别是闭塞性细支气管炎，仍然是肺移植中中、长期的主要问题，对生存率有重大影响。虽然目前尚无针对已确立的闭塞性细支气管炎的治疗方法，但新的预防策略有可能减轻这种可怕并发症的负担。不幸的是，肺移植领域的随机前瞻性研究很少，并且从涉及肾脏或肝脏受者的更大研究中获得的数据并不总是适用于此目的。
