Sommerwerck U, Rabis T, Fleimisch P, Carstens H, Teschler H, Kamler M
Abt. f. Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Deutschland,
Herz. 2014 Feb;39(1):74-83. doi: 10.1007/s00059-013-4044-3.
Lung transplantation is a therapeutic option for patients with end-stage lung diseases. Selection of candidates requires careful consideration of the disease-specific indications and contraindications for transplantation. Advances have been made in candidate selection via the ability to prognosticate outcomes of various lung diseases and through the implementation of the lung allocation score (LAS) with specific consideration of the degree of urgency and good postoperative survival rate, after neglecting the waiting time. This system has resulted in decreased mortality on the waiting list for lung transplantation. The availability of donor organs can possibly be increased by implementation of ex vivo lung perfusion as an alternative to conventional organ preservation. Risk factors for poor outcomes post-lung transplantation have been identified and understanding of the physiological, cellular and molecular mechanisms responsible for lung and airway damage has been extensively expanded. Primary graft dysfunction, infectious diseases, acute rejection, antibody-mediated rejection, lymphocytic bronchiolitis, obliterative bronchiolitis, restrictive allograft syndrome, and chronic lung allograft dysfunction are well defined complications and continue to be common causes of morbidity and mortality. This article provides a comprehensive update on these topics for the non-transplantation clinician.
肺移植是终末期肺部疾病患者的一种治疗选择。候选者的选择需要仔细考虑移植的疾病特异性适应症和禁忌症。通过预测各种肺部疾病的预后能力以及实施肺分配评分（LAS），在忽略等待时间的情况下特别考虑紧急程度和良好的术后生存率，候选者选择方面取得了进展。该系统降低了肺移植等待名单上的死亡率。作为传统器官保存的替代方法，实施体外肺灌注可能会增加供体器官的可用性。已经确定了肺移植后不良结局的危险因素，并且对导致肺和气道损伤的生理、细胞和分子机制的理解有了广泛扩展。原发性移植功能障碍、传染病、急性排斥反应、抗体介导的排斥反应、淋巴细胞性细支气管炎、闭塞性细支气管炎、限制性同种异体移植综合征和慢性肺同种异体移植功能障碍是明确的并发症，仍然是发病和死亡的常见原因。本文为非移植临床医生提供了关于这些主题的全面更新。
