Ainge-Allen Henry W, Glanville Allan R
The Lung Transplant Unit, St. Vincent's Hospital, Sydney, NSW, Australia.
Ann Transl Med. 2020 Mar;8(6):408. doi: 10.21037/atm.2019.11.61.
Selection criteria for the referral and potential listing of patients for lung transplantation (LTx) have changed considerably over the last three decades but one key maxim prevails, the ultimate focus is to increase longevity and quality of life by careful utilization of a rare and precious resource, the donor organs. In this article, we review how the changes have developed and the outcomes of those changes, highlighting the impact of the lung allocation score (LAS) system. Major diseases, including interstitial lung disease (ILD), chronic obstructive pulmonary disease and pulmonary hypertension are considered in detail as well as the concept of retransplantation where appropriate. Results from bridging to LTx using extracorporeal membrane oxygenation (ECMO) are discussed and other potential contraindications evaluated such as advanced age, frailty and resistant infections. Given the multiplicity of risk factors it is a credit to those working in the field that such excellent and improving results are obtained with an ongoing dedication to achieving best practice.
在过去三十年中，肺移植（LTx）患者转诊及潜在入列的选择标准发生了相当大的变化，但有一条关键准则始终适用，即最终目标是通过谨慎利用稀有而珍贵的资源——供体器官，来延长患者寿命并提高生活质量。在本文中，我们回顾这些变化是如何发展的以及这些变化带来的结果，重点强调肺分配评分（LAS）系统的影响。详细探讨了包括间质性肺疾病（ILD）、慢性阻塞性肺疾病和肺动脉高压在内的主要疾病，以及在适当情况下再次移植的概念。讨论了使用体外膜肺氧合（ECMO）过渡到肺移植的结果，并评估了其他潜在的禁忌证，如高龄、身体虚弱和耐药感染。鉴于存在多种风险因素，该领域的工作人员能够通过持续致力于实现最佳实践而取得如此优异且不断改善的结果，值得称赞。
