Pulmonary Transplantation and Ischemia-Reperfusion Injury

摘要: Lung transplantation provides a curative hope for many with end-stage pulmonary disease. Since the first attempt at human lung in 1963, scientific and surgical advancements have supported improved survival quality of life transplant recipients (Hardy, et al., 1963). Significant contributions cardiopulmonary bypass, pharmacologic immunosuppression, donor-recipient risk stratification increased success associated clinical adoption this treatment strategy. Continued research efforts novel methods organ preservation, donor graft selection, recipient support promising future transplantation. Improvements technique perioperative care over past two decades led to 30-fold increase number worldwide 2,769 patients 2008 (Christie, 2010). 1994, bilateral has supplanted single as primary strategy replacement now account 71% transplants performed In 2010, indications included chronic obstructive disease (35.5%), idiopathic fibrosis (22.1%), cystic (16.0%) Despite evolution increasing transplantation, long-term shown minimal improvement. outcomes remain poorest any solid transplant, international estimates demonstrating 21% one-year 50% five-year mortality ischemia-reperfusion (IR) injury following imposes significant threat (Diamond & Christie, IR is main cause failure significantly increases acute rejection dysfunction (de Perrot, 2003). Multivariate analysis function implicated an independent predictor bronchiolitis obliterans syndrome (BOS), most common morbidity after (Fiser, 2002). IR-induced characterized by nonspecific alveolar damage, edema, hypoxemia occurring within 72 hours The estimated incidence 41% 30-day 40%, compared 7%