Zenati M, Dowling R D, Armitage J M, Kormos R L, Dummer J S, Hardesty R L, Griffith B P
Department of Surgery, University of Pittsburgh, Pennsylvania.
Ann Thorac Surg. 1989 Dec;48(6):882-6. doi: 10.1016/0003-4975(89)90696-6.
Selection of suitable donors is critical to the success of clinical pulmonary transplantation. Requirements for lung donors, management before explantation, and methods of preservation were reviewed for the 70 heart-lung, eight double-lung, and two single-lung transplantations performed at the University of Pittsburgh since 1982. Careful observation of trends of hyperoxygenation studies, chest roentgenograms, and Gram stain and culture results of tracheal secretions, as well as findings on bronchoscopy, can help identify which lungs not only have adequate function but are acceptable for transplantation. In spite of the rigid criteria used, 76% of tracheal cultures from donors deemed acceptable grew organisms. The presence of oropharyngeal flora has been shown to correlate with the development of early intrathoracic infections in the recipient. Prophylactic broad-spectrum antibiotic treatment of the donor is desirable to treat microbial contamination that could cause focal injury to the donor lung and predispose to infection in the recipient. Acceptance of less than ideal donors is ill-advised even though rejection of such donors conflicts with the current shortage of organs.
选择合适的供体对于临床肺移植的成功至关重要。自1982年以来，匹兹堡大学进行了70例心肺移植、8例双肺移植和2例单肺移植，对肺供体的要求、植入前的管理及保存方法进行了回顾。仔细观察高氧研究趋势、胸部X线片、气管分泌物的革兰氏染色及培养结果，以及支气管镜检查结果，有助于确定哪些肺不仅功能良好而且适合移植。尽管采用了严格的标准，但在被认为合格的供体中，76%的气管培养物生长出微生物。已证明口咽菌群的存在与受者早期胸腔内感染的发生相关。对供体进行预防性广谱抗生素治疗，以处理可能导致供体肺局灶性损伤并使受者易发生感染的微生物污染是可取的。即使拒绝不太理想的供体与当前器官短缺的情况相矛盾，但接受这类供体也是不明智的。
