Emory University School of Medicine, Atlanta, Georgia, USA.
Curr Opin Organ Transplant. 2021 Jun 1;26(3):302-308. doi: 10.1097/MOT.0000000000000879.
Over the past two decades, lung transplant has become the mainstay of treatment for several end-stage lung diseases. As the field continues to evolve, the criteria for referral and listing have also changed. The last update to these guidelines was in 2014 and several studies since then have changed how patients are transplanted. Our article aims to briefly discuss these updates in lung transplantation.
This article discusses the importance of early referral of patients for lung transplantation and the concept of the 'transplant window'. We review the referral and listing criteria for some common pulmonary diseases and also cite the updated literature surrounding the absolute and relative contraindications keeping in mind that they are a constantly moving target. Frailty and psychosocial barriers are difficult to assess with the current assessment tools but continue to impact posttransplant outcomes. Finally, we discuss the limited data on transplantation in acute respiratory distress syndrome (ARDS) due to COVID19 as well as extracorporeal membrane oxygenation bridge to transplantation.
The findings discussed in this article will strongly impact, if not already, how we select candidates for lung transplantation. It also addresses some aspects of lung transplant such as frailty and ARDS, which need better assessment tools and clinical data.
在过去的二十年中，肺移植已成为多种终末期肺部疾病的主要治疗方法。随着该领域的不断发展，转诊和列入名单的标准也发生了变化。这些指南的最新更新是在 2014 年，此后的几项研究改变了患者的移植方式。本文旨在简要讨论肺移植领域的这些更新。
本文讨论了患者早期转诊进行肺移植的重要性以及“移植窗口”的概念。我们回顾了一些常见肺部疾病的转诊和列入名单标准，并引用了最新的文献，同时牢记这些标准是一个不断变化的目标，绝对和相对禁忌症。虚弱和社会心理障碍很难用当前的评估工具来评估，但仍会影响移植后的结果。最后，我们讨论了由于 COVID19 导致的急性呼吸窘迫综合征（ARDS）和体外膜氧合桥接移植的移植数据有限。
本文讨论的发现将强烈影响（如果尚未影响）我们选择肺移植候选人的方式。它还涉及肺移植的一些方面，如虚弱和 ARDS，这些方面需要更好的评估工具和临床数据。
