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Abstract
En 中文
Respiratory diseases account for one in five deaths in the UK.(1) Lung transplantation is the only realistic therapeutic option for selected patients with end-stage chronic lung disease and provides dramatic improvements in both survival and quality of life. In younger patients with life-threatening cystic fibrosis (CF) lung disease, median survival after lung transplant now exceeds 10 years. However, 20-30% of patients waiting for lung transplantation will die before a donor organ becomes available. Although a shortage of multiorgan donors contributes, the main problem is that in multiorgan donors lungs are very susceptible to dysfunction, and about 80% of potential donor lungs in the UK are deemed unusable for clinical lung transplantation. It has previously been suggested that, in addition to promoting more organ donation, better use of existing organ donors is an important way to increase the numbers of lung transplants performed, 2 and many centres worldwide have increased donor lung use by accepting more 'marginal' or 'extended criteria' donors. This, however, is not without risks to early post-transplantation outcomes. 3 The major early cause of death after lung transplantation is primary graft dysfunction (PGD), a severe lung injury akin to acute respiratory distress syndrome. Evidence that PGD has a major impact on survival comes from experience in several centres worldwide, 4 and from the International Society for Heart and Lung Transplantation (ISHLT); the reported incidences of PGD are up to 25%, and PGD is associated with 30-day mortality of 50%, compared with < 10% among those without PGD.(5) There is, therefore, an urgent clinical need to safely increase the utilisation of donor lungs from the existing donor pool without negatively impacting on early survival after lung transplant.
Keywords:
VIVO LUNG PERFUSION
PRIMARY GRAFT DYSFUNCTION
REJECTED DONOR LUNGS
ISHLT WORKING GROUP
INTERNATIONAL-SOCIETY
INTERLEUKIN-10 GENE
INFORMED-CONSENT
BRAIN-DEATH
RAT LUNG
TRANSPLANTATION
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