Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA; email:
Duke Clinical Research Institute, Durham, North Carolina 27710, USA.
Annu Rev Med. 2021 Jan 27;72:135-149. doi: 10.1146/annurev-med-080119-103200. Epub 2020 Oct 28.
Lung transplantation improves survival and quality of life in patients with advanced pulmonary disease. Over the past several decades, the volume of lung transplants has grown substantially, with increasing transplantation of older and acutely ill individuals facilitated by improved utilization and preservation of available donor organs. Other advances include improvements in the diagnosis and mechanistic understanding of frequent post-transplant complications, such as primary graft dysfunction, acute rejection, and chronic lung allograft dysfunction (CLAD). CLAD occurs as a result of the host immune response to the allograft and is the principal factor limiting long-term survival after lung transplantation. Two distinct clinical phenotypes of CLAD have emerged, bronchiolitis obliterans syndrome and restrictive allograft syndrome, and this distinction has enabled further understanding of underlying immune mechanisms. Building on these advances, ongoing studies are exploring novel approaches to diagnose, prevent, and treat CLAD. Such studies are necessary to improve long-term outcomes for lung transplant recipients.
肺移植可改善晚期肺部疾病患者的生存率和生活质量。在过去几十年中，肺移植的数量大幅增加，通过更好地利用和保存可用供体器官，使更多的老年和急性重症患者接受了肺移植。其他进展包括提高了对常见移植后并发症（如原发性移植物功能障碍、急性排斥反应和慢性肺移植物功能障碍 (CLAD)）的诊断和机制理解。CLAD 是由于宿主对移植物的免疫反应引起的，是限制肺移植后长期生存的主要因素。CLAD 出现了两种不同的临床表型，即闭塞性细支气管炎综合征和限制性移植物综合征，这种区分使人们进一步了解了潜在的免疫机制。在此基础上，正在进行的研究探索了诊断、预防和治疗 CLAD 的新方法。这些研究对于改善肺移植受者的长期预后是必要的。
