Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada.
Mazankowski Alberta Heart Institute, Edmonton, AB T6G 2B7, Canada.
Cells. 2021 Jun 7;10(6):1417. doi: 10.3390/cells10061417.
Lung transplantation (LTx) is the gold standard treatment for end-stage lung disease; however, waitlist mortality remains high due to a shortage of suitable donor lungs. Organ quality can be compromised by lung ischemic reperfusion injury (LIRI). LIRI causes pulmonary endothelial inflammation and may lead to primary graft dysfunction (PGD). PGD is a significant cause of morbidity and mortality post-LTx. Research into preservation strategies that decrease the risk of LIRI and PGD is needed, and ex-situ lung perfusion (ESLP) is the foremost technological advancement in this field. This review addresses three major topics in the field of LTx: first, we review the clinical manifestation of LIRI post-LTx; second, we discuss the pathophysiology of LIRI that leads to pulmonary endothelial inflammation and PGD; and third, we present the role of ESLP as a therapeutic vehicle to mitigate this physiologic insult, increase the rates of donor organ utilization, and improve patient outcomes.
肺移植（LTx）是治疗终末期肺病的金标准疗法；然而，由于合适的供体肺短缺，等待名单上的死亡率仍然很高。器官质量可能因肺缺血再灌注损伤（LIRI）而受损。LIRI 会引起肺内皮炎症，并可能导致原发性移植物功能障碍（PGD）。PGD 是 LTx 后发病率和死亡率的一个重要原因。需要研究降低 LIRI 和 PGD 风险的保存策略，而离体肺灌注（ESLP）是该领域最重要的技术进步。这篇综述讨论了 LTx 领域的三个主要主题：首先，我们回顾了 LTx 后 LIRI 的临床表现；其次，我们讨论了导致肺内皮炎症和 PGD 的 LIRI 的病理生理学；最后，我们介绍了 ESLP 作为一种治疗手段的作用，以减轻这种生理损伤，提高供体器官的利用率，并改善患者的预后。
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