Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200433, Shanghai, Zhejiang, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200433, Shanghai, Zhejiang, China.
Expert Rev Respir Med. 2022 Nov-Dec;16(11-12):1191-1203. doi: 10.1080/17476348.2022.2157264. Epub 2022 Dec 12.
Lung transplantation (LTx) remains the only therapeutic strategy for patients with incurable lung diseases. However, its use has been severely limited by the narrow donor pool and potential concerns of inferior quality of donor lungs, which are more susceptible to external influence than other transplant organs. Multiple insults, including various causes of death and a series of perimortem events, may act together on donor lungs and eventually culminate in primary graft dysfunction (PGD) after transplantation as well as other poor short-term outcomes.
This review focuses on the predisposing factors contributing to injuries to the donor lungs, specifically focusing on the pathogenesis of these injuries and their impact on post-transplant outcomes. Additionally, various maneuvers to mitigate donor lung injuries have been proposed.
The selection criteria for eligible donors vary and may be poor discriminators of lung injury. Not all transplanted lungs are in ideal condition. With the rapidly increasing waiting list for LTx, the trend of using marginal donors has become more apparent, underscoring the need to gain a deeper understanding of donor lung injuries and discover more donor resources.
肺移植（LTx）仍然是治疗无法治愈的肺部疾病患者的唯一治疗策略。然而，由于供体来源有限，以及潜在的对供体肺质量较差的担忧，其应用受到了严重限制，供体肺比其他移植器官更容易受到外部影响。多种损伤因素，包括各种死因和一系列濒死期事件，可能共同作用于供体肺，并最终导致移植后原发性移植物功能障碍（PGD）以及其他不良的短期预后。
本综述重点介绍了导致供体肺损伤的易患因素，特别关注这些损伤的发病机制及其对移植后结局的影响。此外，还提出了各种减轻供体肺损伤的操作方法。
合格供体的选择标准各不相同，可能无法很好地区分肺损伤。并非所有移植的肺都处于理想状态。随着 LTx 等待名单的迅速增加，使用边缘供体的趋势变得更加明显，这突显了需要更深入地了解供体肺损伤并寻找更多的供体资源。
