Chen Fengshi, Date Hiroshi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Curr Opin Organ Transplant. 2015 Oct;20(5):515-20. doi: 10.1097/MOT.0000000000000234.
Primary graft failure, which represents one of the most frequent causes of early mortality, is mostly caused by ischemia-reperfusion injury (IRI). IRI may also induce rejection, which is the principal cause of mortality after transplantation. It is essential to understand the mechanism of pulmonary IRI for improving the outcomes of lung transplantation, and therefore we reviewed the state of the art concerning pulmonary IRI in lung transplantation.
Numerous strategies have been conducted to reduce IRI after lung transplantation both from the experimental and clinical aspects. The greatest efforts have been done in the method of lung preservation and reperfusion. Recently, ex-vivo lung perfusion system was developed and has been clinically introduced. Furthermore, more experimental studies to understand the pathophysiology of IRI and to alleviate lung IRI have been performed worldwide, and various new treatment modalities including inhalation therapy with therapeutic gases and substances, fibrinolytic treatment, subzero preservation, and mesenchymal stromal cell therapy are going to be applied to the clinical practice.
IRI, whose pathophysiology remains incompletely understood, is one of the most critical phenomena in lung transplantation, and therefore more studies to control pulmonary IRI are required for improving the outcomes of lung transplantation.
原发性移植肺功能衰竭是早期死亡的常见原因之一，主要由缺血再灌注损伤（IRI）引起。IRI还可能诱发排斥反应，而排斥反应是移植后死亡的主要原因。了解肺IRI的机制对于改善肺移植结局至关重要，因此我们综述了肺移植中肺IRI的最新研究状况。
从实验和临床方面都采取了多种策略来减少肺移植后的IRI。在肺保存和再灌注方法上付出了巨大努力。最近，体外肺灌注系统得以开发并已应用于临床。此外，全球范围内开展了更多旨在了解IRI病理生理学和减轻肺IRI的实验研究，包括使用治疗性气体和物质的吸入疗法、纤溶治疗、亚低温保存和间充质基质细胞疗法等各种新的治疗方式即将应用于临床实践。
IRI的病理生理学仍未完全阐明，它是肺移植中最关键的现象之一，因此需要开展更多研究来控制肺IRI，以改善肺移植结局。
