Columbia University College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th St, PH 14, Room 108, New York, NY 10032, USA.
Columbia University College of Physicians and Surgeons, Division Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, 622 West 168th St, PH 14, Room 104, New York, NY 10032, USA.
Best Pract Res Clin Anaesthesiol. 2017 Jun;31(2):285-297. doi: 10.1016/j.bpa.2017.05.006. Epub 2017 May 30.
Lung transplantation is an established treatment for patients with end-stage lung disease. Improvements in immunosuppression and therapeutic management of infections have resulted in improved long-term survival and a decline in allograft rejection. Allograft rejection continues to be a serious complication following lung transplantation, thereby leading to acute graft failure and, subsequently, chronic lung allograft dysfunction (CLAD). Bronchiolitis obliterans syndrome (BOS), the most common phenotype of CLAD, is the leading cause of late mortality and morbidity in lung recipients, with 50% having developed BOS within 5 years of lung transplantation. Infections in lung transplant recipients are also a significant complication and represent the most common cause of death within the first year. The success of lung transplantation depends on careful management of immunosuppressive regimens to reduce the rate of rejection, while monitoring recipients for infections and complications to help identify problems early. The long-term outcomes and management of lung transplant recipients are critically based on modulating natural immune response of the recipient to prevent acute and chronic rejection. Understanding the immune mechanisms and temporal correlation of acute and chronic rejection is thus critical in the long-term management of lung recipients.
肺移植是治疗终末期肺病患者的一种成熟治疗方法。免疫抑制和感染治疗管理的改进导致了长期生存的改善和移植物排斥反应的减少。移植物排斥反应仍然是肺移植后的严重并发症，从而导致急性移植物衰竭，随后导致慢性肺移植物功能障碍（CLAD）。闭塞性细支气管炎综合征（BOS）是 CLAD 的最常见表型，是肺移植受者晚期死亡和发病率的主要原因，50%的患者在肺移植后 5 年内出现 BOS。肺移植受者的感染也是一个严重的并发症，是肺移植受者在一年内死亡的最常见原因。肺移植的成功取决于仔细管理免疫抑制方案以降低排斥反应的发生率，同时监测受者的感染和并发症，以便及早发现问题。肺移植受者的长期结果和管理主要取决于调节受者的天然免疫反应，以预防急性和慢性排斥反应。因此，了解急性和慢性排斥反应的免疫机制和时间相关性对于肺移植受者的长期管理至关重要。
