Department of Thoracic Surgery, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan.
Cells. 2021 May 28;10(6):1333. doi: 10.3390/cells10061333.
Lung transplantation has been established worldwide as the last treatment for end-stage respiratory failure. However, ischemia-reperfusion injury (IRI) inevitably occurs after lung transplantation. The most severe form of IRI leads to primary graft failure, which is an important cause of morbidity and mortality after lung transplantation. IRI may also induce rejection, which is the main cause of mortality in recipients. Despite advances in donor management and graft preservation, most donor grafts are still unsuitable for transplantation. Although the pulmonary endothelium is the primary target site of IRI, the pathophysiology of lung IRI remains incompletely understood. It is essential to understand the mechanism of pulmonary IRI to improve the outcomes of lung transplantation. Therefore, we reviewed the state-of-the-art in the management of pulmonary IRI after lung transplantation. Recently, the ex vivo lung perfusion (EVLP) system has been clinically introduced worldwide. Various promising therapeutic strategies for the protection of the endothelium against IRI, including EVLP, inhalation therapy with therapeutic gases and substances, fibrinolytic treatment, and mesenchymal stromal cell therapy, are awaiting clinical application. We herein review the latest advances in the field of pulmonary IRI in lung transplantation.
肺移植已在全球范围内确立为治疗终末期呼吸衰竭的最后手段。然而，肺移植后不可避免地会发生缺血再灌注损伤（IRI）。最严重的 IRI 形式导致原发性移植物功能衰竭，这是肺移植后发病率和死亡率的重要原因。IRI 还可能引发排斥反应，这是受者死亡的主要原因。尽管在供体管理和移植物保存方面取得了进展，但大多数供体移植物仍不适合移植。尽管肺血管内皮是 IRI 的主要靶位，但肺 IRI 的病理生理学仍不完全清楚。了解肺 IRI 的机制对于改善肺移植的结果至关重要。因此，我们综述了肺移植后肺 IRI 的管理现状。最近，体外肺灌注（EVLP）系统已在全球范围内临床引入。各种有前途的针对 IRI 的内皮保护治疗策略，包括 EVLP、治疗性气体和物质的吸入治疗、纤维蛋白溶解治疗和间充质基质细胞治疗，正在等待临床应用。我们在此综述了肺移植中肺 IRI 领域的最新进展。
