Molecular Biosciences, University of Technology Sydney.
Thoracic Medicine, St Vincent's Hospital Sydney.
Curr Opin Organ Transplant. 2019 Jun;24(3):305-310. doi: 10.1097/MOT.0000000000000631.
Lung transplantation survival is still limited compared with other solid organ transplant modalities, due to a range of factors that are continuing to be elucidated. However, new research is emerging which indicates that the microbiome of the lungs, and of other organs, may have important implications for immune response and mediating transplant outcomes. Pathogenic bacterial and viral species are known to have deleterious effects on the allograft, but taking a more global view, and considering the overall composition of the community of microbial species may undercover a greater understanding of the complex interplay involved in allograft dysfunction.
The microbiome appears to have an important modulatory role on immune response in both normal development, and after transplantation. A range of microbial species contributes to the resident microscopic community, with the gut and blood microbiomes having a significant impact on the function of the lungs and resistance to infection. Movement of species from within and outside the respiratory tract occurs in the early transplant period, leading to a modified donor microbiome in the recipient. There is evidence to suggest that chronic lung allograft dysfunction may be facilitated by the respiratory microbiome and interactions with immune cells within the allograft.
Further investigation of the respiratory microbiome, interactions with the microbiome of other organs and impact on immune and allograft function posttransplantation is needed. Promising insights are being gained regarding certain microbial profiles which may be associated with negative outcomes, and the mechanisms through which this occurs. As our understanding expands, the ability to modify the microbiome offers novel treatment strategies for combating allograft dysfunction.
与其他实体器官移植方式相比，肺移植的存活率仍然有限，这是由于一系列因素仍在研究中。然而，新的研究表明，肺部和其他器官的微生物组可能对免疫反应和调节移植结果有重要影响。已知致病性细菌和病毒对移植物有有害影响，但从更广泛的角度来看，考虑微生物物种的整体组成可能会更深入地了解移植物功能障碍中涉及的复杂相互作用。
微生物组似乎在正常发育和移植后对免疫反应具有重要的调节作用。一系列微生物物种有助于维持常驻微生物群落，肠道和血液微生物组对肺部功能和抗感染能力有重大影响。在移植早期，来自呼吸道内外的物种发生转移，导致受体内供体微生物组发生改变。有证据表明，慢性肺移植物功能障碍可能是由呼吸微生物组和与移植物内免疫细胞的相互作用促进的。
需要进一步研究呼吸微生物组、与其他器官微生物组的相互作用以及移植后对免疫和移植物功能的影响。关于某些可能与不良结果相关的微生物特征及其发生机制，正在获得有希望的见解。随着我们理解的扩展，修饰微生物组为对抗移植物功能障碍提供了新的治疗策略。
