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肺移植后的静脉血栓栓塞症

Venous thromboembolism following lung transplantation.

作者信息

Sunder Thirugnanasambandan, Thangaraj Paul Ramesh, Kuppusamy Madhan Kumar

机构信息

Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Chennai 600086, Tamil Nadu, India.

出版信息

World J Transplant. 2025 Jun 18;15(2):99241. doi: 10.5500/wjt.v15.i2.99241.

Abstract

Lung transplantation (LT) is currently a surgical therapy option for end-stage lung disease. Venous thromboembolism (VTE), which can occur after LT, is associated with significant morbidity and mortality. Because of improved outcomes, increasing numbers of patients are receiving LT as treatment. Patients on the waitlist for LT tend to be older with weakness and frailty in addition to pulmonary symptoms. These factors contribute to a heightened risk of postoperative VTE. Furthermore, patients who clinically deteriorate while on the waitlist may require extra corporeal membrane oxygenation as a bridge to LT. Bleeding and thromboembolism are common in these patients. Pulmonary embolism (PE) in a freshly transplanted lung can have significant effects leading to morbidity and mortality. PE typically leads to impairment of gas exchange and right ventricular strain. In LT, PE can affect healing of bronchial anastomosis and may even contribute to the development of chronic allograft lung dysfunction. This article discussed the incidence, clinical features and diagnosis of VTE after LT. Furthermore, the treatment modalities, complications, and outcomes of VTE were reviewed.

摘要

肺移植(LT)目前是终末期肺病的一种外科治疗选择。静脉血栓栓塞(VTE)可发生在肺移植术后,与显著的发病率和死亡率相关。由于治疗效果的改善,越来越多的患者接受肺移植作为治疗手段。等待肺移植的患者往往年龄较大,除了肺部症状外,还伴有虚弱和身体机能下降。这些因素导致术后VTE风险增加。此外,在等待名单上临床病情恶化的患者可能需要体外膜肺氧合作为肺移植的过渡。出血和血栓栓塞在这些患者中很常见。新近移植肺中的肺栓塞(PE)可产生显著影响,导致发病和死亡。PE通常会导致气体交换受损和右心室劳损。在肺移植中,PE会影响支气管吻合口的愈合,甚至可能导致慢性移植肺功能障碍的发生。本文讨论了肺移植术后VTE的发病率、临床特征和诊断。此外,还回顾了VTE的治疗方式、并发症和治疗结果。

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