Girgis Reda E, Hadley Ryan J, Murphy Edward T
Richard DeVos Lung Transplant Program, Corewell Health West, Michigan State University, College of Human Medicine, Grand Rapids, Michigan, USA.
Glob Cardiol Sci Pract. 2023 Aug 1;2023(3):e202318. doi: 10.21542/gcsp.2023.18.
Lung transplantation volumes and survival rates continue to increase worldwide. Primary graft dysfunction (PGD) and acute kidney injury (AKI) are common early postoperative complications that significantly affect short-term mortality and long-term outcomes. These conditions share overlapping risk factors and are driven, in part, by circulatory derangements. The prevalence of severe PGD is up to 20% and is the leading cause of early death. Patients with pulmonary hypertension are at a higher risk. Prevention and management are based on principles learned from acute lung injury of other causes. Targeting the lowest effective cardiac filling pressure will reduce alveolar edema formation in the setting of increased pulmonary capillary permeability. AKI is reported in up to one-half of lung transplant recipients and is strongly associated with one-year mortality as well as long-term chronic kidney disease. Optimization of renal perfusion is critical to reduce the incidence and severity of AKI. In this review, we highlight key early post-transplant pulmonary, circulatory, and renal perturbations and our center's management approach.
全球范围内，肺移植的数量和生存率持续上升。原发性移植肺功能障碍（PGD）和急性肾损伤（AKI）是常见的术后早期并发症，会显著影响短期死亡率和长期预后。这些病症存在重叠的风险因素，部分由循环紊乱所致。严重PGD的发生率高达20%，是早期死亡的主要原因。肺动脉高压患者的风险更高。预防和管理基于从其他病因的急性肺损伤中汲取的原则。在肺毛细血管通透性增加的情况下，将心脏充盈压维持在最低有效水平可减少肺泡水肿的形成。高达一半的肺移植受者会出现AKI，且其与一年死亡率以及长期慢性肾病密切相关。优化肾脏灌注对于降低AKI的发生率和严重程度至关重要。在本综述中，我们重点介绍了移植后早期关键的肺部、循环和肾脏紊乱情况以及我们中心的管理方法。
