Lung transplantation. Lung preservation

Over the past decade, improvements in the technique of lung preservation have led to significant reduction in the incidence of ischemia-reperfusion-induced lung injury after lung transplantation. The challenge remains to improve the number of donor lungs available for transplantation. While the number of patients on the waiting list is constantly increasing, only 10% to 30% of donor lungs are currently being used for transplantation. Hence, the development of new strategies to assess, repair, and improve the quality of the lungs could have a tremendous impact on the number of transplants performed. In addition, an improved understanding of the mechanisms involved in lung preservation might help elucidate the potential link between acute lung injury and chronic graft dysfunction. In the future, genetic analysis using novel technologies such as microarray analysis will help researchers determine which genes control the injury seen in the transplantation process. Hopefully, this information will provide new insights into the mechanisms of injury and reveal potential new strategies and targets for therapies to improve lung preservation.     

肺移植手术中供肺保存液的研究现状

肺移植手术是治疗终末期肺部疾病的惟一有效方法，但仍然有许多相关问题须待解决。除了供肺严重缺乏外，因缺血-再灌注损伤导致的移植肺功能异常是肺移植手术患者最常见的早期死亡原因之一。保存移植肺的最佳状态对减轻肺移植术后缺血器官功能障碍至关重要。因此，寻找一种高度可靠的肺保存液，对减轻移植肺的缺血-再灌注损伤、提高肺移植术后肺功能有着十分重要的意义。现就供肺保存液的种类、灌注方式、灌注条件及其改良措施的研究现状进行综述。     

Lung cancer

Lung cancer remains the greatest cause of cancer-related death in the United Kingdom despite its lower incidence compared to other cancers. It remains very treatable with excellent outcomes in the early stages; however, many patients present with late symptoms. Investigation of lung cancer has changed significantly over the last decade to allow less invasive staging techniques and, more importantly, less invasive operative techniques to allow surgery in patients that may have previously been denied surgery.     

Lung cancer

Lung cancer remains the greatest cause of cancer-related death in the United Kingdom despite its lower incidence compared to other cancers. It remains very treatable with excellent outcomes in the early stages; however, many patients present with late symptoms. Investigation of lung cancer has changed significantly over the last decade to allow less invasive staging techniques and, more importantly, less invasive operative techniques to allow surgery in patients that may have previously been denied surgery.     

Lung transplantation

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.     

Lung surrogates

In the development and evaluation of mechanical ventilation on the basis of high-frequency oscillation, appropriate surrogates of the lung are important, because they allow the measurement and control of various parameters which are not accessible in animal models. Yet, criteria have to be established according to which results obtained with a surrogate may be assessed with a view to extrapolation to humans. Theoretical considerations and impedance measurements are used for this purpose. It is found that for each given frequency a model can be made which exhibits realistic properties. However, no uniformly valid surrogate in the entire frequency range of 10–50 Hz is available at present.