Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia.
Semin Respir Crit Care Med. 2018 Apr;39(2):138-147. doi: 10.1055/s-0037-1615820. Epub 2018 Mar 26.
Lung transplantation (LTx) has traditionally been limited by a lack of suitable donor lungs. With the recognition that lungs are more robust than initially thought, the size of the donor pool of available lungs has increased dramatically in the past decade. Donation after brain death (DBD) and donation after circulatory death (DCD) lungs, both ideal and extended are now routinely utilized. DBD lungs can be damaged. There are important differences in the public's understanding, legal and consent processes, intensive care unit strategies, lung pathophysiology, logistics, and potential-to-actual donor conversion rates between DBD and DCD. Notwithstanding, the short- and long-term outcomes of LTx from any of these DBD versus DCD donor scenarios are now similar, robust, and continue to improve. Large audits suggest there remains a large untapped pool of DCD (but not DBD) lungs that may yet further dramatically increase lung transplant numbers. Donor scoring systems that might predict the donor conversion rates and lung quality, the role of ex vivo lung perfusion as an assessment and lung resuscitation tool, as well as the potential of donor lung quality biomarkers all have immense promise for the clinical field.
肺移植（LTx）传统上受到缺乏合适供体肺的限制。随着人们认识到肺比最初想象的更具韧性，过去十年中，可供使用的供体肺数量大幅增加。脑死亡后供体（DBD）和循环死亡后供体（DCD）肺，无论是理想的还是扩展的，现在都常规使用。DBD 肺可能受损。在公众的理解、法律和同意程序、重症监护病房策略、肺病理生理学、物流以及 DBD 和 DCD 之间的潜在实际供体转化率方面，存在重要差异。尽管如此，来自这些 DBD 与 DCD 供体场景中的任何一个的 LTx 的短期和长期结果现在都相似、稳健，并持续改善。大型审计表明，仍有大量未开发的 DCD（但不是 DBD）肺可能会进一步大幅增加肺移植数量。预测供体转化率和肺质量的供体评分系统、体外肺灌注作为评估和肺复苏工具的作用，以及供体肺质量生物标志物的潜力，都为临床领域带来了巨大的希望。
