Lung transplantation

Abstract

The supply of donor organs remains extremely limited, and improved methods of maintaining the lungs of potential donors to allow for transplantation must be developed. Currently the upper limit of donor lung ischemic even with our "best" preservation techniques is approximately 4 to 6 hours. Improved methods for preservation will increase the supply of suitable lungs and will considerably simplify the logistics of transplantation just as has occurred with liver transplantation. Efficient use of donor organs remains of paramount importance. We recently performed two single-lung transplants utilizing lungs from one donor. Likewise, there is no reason why a lung could not be sent to another center for transplantation if the harvesting group uses only one lung. Sufficient progress has been achieved to date to warrant continued application of lung transplantation for end-stage pulmonary disease. With increasing experience, one can anticipate refinement of techniques and broader application of these procedures. Single lung transplantation, initially restricted to patients with end-stage pulmonary fibrosis, has now been successfully applied to patients with emphysema, pulmonary hypertension, and other conditions. Although transplantation currently can offer real benefit only to a limited number of persons, it serves to create hope for many others. An additional benefit may prove to be the interest and attention that transplantation focuses on patients with end-stage lung disease and on the pathophysiology of chronic respiratory failure. Knowledge gained may ultimately result in the prevention of many of the disorders for which lung transplantation currently offers the only hope.

Aprotinin decreases reperfusion injury and allograft dysfunction in clinical lung transplantation☆

“…We used well-established criteria for accepting donor lungs including objective evidence of adequate gas exchange and bronchoscopic evaluation to exclude aspiration or purulent secretions [5]. Standardized organ procurement and recipient implantation techniques were utilized for lung transplantation.…”

Pulmonary Rehabilitation in Lung Transplantation

“…Transplantasyon sonrası akut dönemde karşılaşıla-bilecek problemler bozulmuş gaz değişimi, şant, etkin olmayan hava yolu temizliği ve akciğer sıvı dengesinde etkilenimdir (17). Entübasyon ve mekanik ventilasyon, cerrahi süreçteki uzamış statik pozisyon, immünsup-resif tedavi, ağrı, sırtüstü yatış ve kısıtlı mobilite ise bu problemlere zemin hazırlar (3).…”

“…Akciğer transplantasyonu uygulanan kişilerde etkin olmayan öksürme sıklıkla insizyonel ağrı ve denerve akciğere bağlı transplante edilmiş hava yollarında azalmış duyu sonucu oluşmaktadır (17). Yeterli ağrı kontrolü, optimal pozisyonlama ve öksürme tekniklerindeki modifikasyonlar öksürmenin etkinliğini artırabilir.…”

Perioperative anaesthetic considerations for patients undergoing lung transplantation

“…26 Human leukocyte antigen (HLA) matching is not performed because the lungs can deteriorate during the time required for matching and HLA matching has not been shown to correlate with the frequency of chronic rejection. 29 Where possible, CMV serology should be negative or identical to that of the recipient. 3~ However, recent data from the St. Louis International Lung Transplant Registry failed to demonstrate survival advantage at one and two years posttransplantation by avoiding donor-recipient CMV mismatching.…”