Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Eur J Cardiothorac Surg. 2024 Oct 1;66(4). doi: 10.1093/ejcts/ezae338.
The lung microbiome plays a crucial role in the development of chronic lung diseases, which may ultimately lead to the need for lung transplantation. Also, perioperative results seem to be connected with altered lung microbiomes and its dynamic changes providing a possible target for optimizing short-term outcome after transplantation. A literature review using MEDLINE, PubMed Central and Bookshelf was performed. Chronic lung allograft dysfunction (CLAD) seems to be influenced and partly triggered by changes in the pulmonary microbiome and dysbiosis, e.g. through increased bacterial load or abundance of specific species such as Pseudomonas aeruginosa. Additionally, the specific indications for transplantation, with their very heterogeneous changes and influences on the pulmonary microbiome, influence long-term outcome. Next to composition and measurable bacterial load, dynamic changes in the allografts microbiome also possess the ability to alter long-term outcomes negatively. This review discusses the "new" microbiome after transplantation and the associations with direct postoperative outcome. With the knowledge of these principles the impact of alterations in the pulmonary microbiome in hindsight to CLAD and possible therapeutic implications are described and discussed. The aim of this review is to summarize the current literature regarding pre- and postoperative lung microbiomes and how they influence different lung diseases on their progression to failure of conservative treatment. This review provides a summary of current literature for centres looking for further options in optimizing lung transplant outcomes and highlights possible areas for further research activities investigating the pulmonary microbiome in connection to transplantation.
肺微生物组在慢性肺部疾病的发展中起着至关重要的作用，这可能最终导致需要进行肺移植。此外，围手术期结果似乎与改变的肺微生物组及其动态变化有关，这为优化移植后短期结果提供了一个可能的目标。使用 MEDLINE、PubMed Central 和 Bookshelf 进行了文献回顾。慢性肺移植物功能障碍（CLAD）似乎受到肺部微生物组和生态失调变化的影响，部分是由细菌负荷增加或铜绿假单胞菌等特定物种的丰度增加等因素触发的。此外，移植的具体适应症及其对肺部微生物组的非常异质的变化和影响，也会影响长期结果。除了组成和可测量的细菌负荷外，移植物微生物组的动态变化也有能力产生负面影响，改变长期结果。这篇综述讨论了移植后的“新”微生物组及其与直接术后结果的关联。通过了解这些原则，可以描述和讨论肺部微生物组改变对 CLAD 的影响以及可能的治疗意义。本综述的目的是总结关于术前和术后肺部微生物组的现有文献，以及它们如何影响不同的肺部疾病，使其发展为保守治疗失败。本综述为寻求优化肺移植结果的中心提供了现有文献的摘要，并强调了研究肺部微生物组与移植相关的可能进一步研究活动的领域。
