Objective To investigate the experience of operative technique of donor organ harvesting and lung transplantation in some unusual circumstance, and to improve surgical success ratio of lung transplantation. Methods Lung transplants were preformed in 65 cases, including 47 singlelung transplants and 18 double single lung transplants. All the recipients were suffered from intensive respiratory failure,and nine patients were longterm ventilatordependented of the total. The recipients included emphysema (n=23), pulmonary fibrosis (n=24), pneumosilicosis(n=5), pulmonary tuberculosis(n=2), lymphangioleiomyomatosis(n=1) and ventricular septal defect(VSD) or VSD with Eisenmenger’s syndrome(n=4),bronchiectasis (n=4), diffuse panbronchiolitis (n=1) and primary pulmonary hypertension(n=1). Retrospectively summarize clinical experience of lung transplant operation especially experience of dealing with special circumstances encountered in operation. Results 64 donor organ harvesting were achieved successfully. Inhospital death was 11cases (16.9%) after operation. Early death was due to primary lung graft dysfunction (n=3), severe infection(n=6), acute rejection(n=1), pulmonary vein embolism(n=1). Complications took place after operation in 9 cases, to exploratory thoracotomy to stop bleeding after transplantation in 3 cases, pulmonary artery anastomosis again because of stenosis in 1 case, bronchus stoma stenosis in 3 cases, pulmonary infarction in 2 cases, of which one patient accepted pulmonary lobectomy. Follow-up period was from 1.0 year to 5.6 years of 54 cases. 1year survival rate was 72.3%（47/65）.The pulmonary function was improved and the quality of life is well in most patients of the group. Conclusion To improve the technique of donor organ harvesting and lung transplantation is important to decrease the early mortality after transplantation.
Non-heart-beating donor is an important source for lung transplantation, and has been successfully used in clinical practice for many years with satisfactory outcomes. But donor shortage, imperfect lung preservation techniques and ethical controversies still limit the development of non-heart-beating donor. In recent years, with continuous scientific progress, great progress has been made in each aspect of non-heart-beating donor. Here we review the clinical categories, ischemia time, death determination, ethical progress, and lung preservation techniques of non-heart-beating donor.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
Objective To explore the research hotspots and latest progress of lung transplantation nursing at home and abroad, and to provide reference ideas and directions for the future related research. Methods Through the collection of CNKI and Web of Science core database, the related literature of lung transplantation nursing from inception to December 2023 was retrieved and CiteSpace software was used to focus on keyword co-occurrence, clustering and emergence. Results A total of 352 Chinese literature and 126 English literature were included in this study, and the number of papers published at home and abroad showed an overall upward trend. There were 34 core authors of Chinese literature and 83 core authors of English literature. The core authors led the team to promote research and promote cooperation at home and abroad. At present, the cooperation among research teams needed to be strengthened. Chinese literature keywords included nursing, lung transplantation, extracorporeal membrane oxygenation, lung rehabilitation, lung transplantation surgery, complications. English literature keywords included lung transplanation, quality of life, international society, disease, bone marrow transplantation. There were 15 clusters and 25 emergent keywords in the CNKI database, and 12 clusters and 25 emergent keywords in the Web of Science core database. ConclusionThe study of lung transplantation nursing at home and abroad has been paid more and more attention, and the research is getting more and more sophisticated. The future study can realize the holistic care of patients during perioperative period on the basis of clinical diagnosis and nursing technology, and improve the survival of patients after operation.
ObjectiveTo explore the method for establishing a pig left lung orthotopic transplantation model. MethodsDetailed surgical procedures, including animal anesthesia, tracheal intubation, donor lung retrieval, and recipient transplantation, were thoroughly reported. By examining the histological morphology and blood gas analysis of the transplanted lung 2 hours after reperfusion, the histological changes and function of the transplanted lung were assessed. ResultsThis method was applied to four male Yorkshire pigs with an average weight of (40.0 ±2.5) kg for left lung in situ transplantation, effectively simulating conditions relevant to human lung transplantation. Two hours after the transplantation, arterial blood gas analysis showed PaO2 was 155.4-178.6 mm Hg, PaCO2 was 53.1-62.4 mm Hg, and the oxygenation index was 310.8-357.2 mm Hg. Hematoxylin and eosin staining indicated a low degree of pulmonary edema and minimal cellular infiltration. ConclusionThe pig left lung orthotopic transplantation model possesses strong operability and stability. Researchers can replicate this model according to the described methods and further conduct basic research and explore clinical translational applications.
ObjectiveTo analyze the benefits of lung transplantation in the treatment of interstitial lung disease (ILD) and investigate its prognostic factors.MethodsThe clinical data of patients diagnosed with ILD and meet the lung transplantation criteria were retrospectively analyzed from January 2012 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University. A total of 111 patients, 88 males and 23 females, aged (58.3±11.4) years old, were divided into lung transplantation group and non-lung transplantation group. Clinical data and prognosis of the two groups were compared and the factors affecting the prognosis of lung transplantation were analyzed with relevant literatures. Results There were 56 patients in lung transplantation group and 55 patients in non-lung transplantation group. The mainly underlying disease of both groups were idiopathic pulmonary fibrosis (IPF). There was no significant difference in age, body mass index, arterial partial pressure of oxygen, percentage of forced vital capacity in the estimated value, percentage of diffusing capacity of the lung for carbon monoxide in the estimated value, six-minute walk distance between the two groups (P>0.05). The pulmonary arterial hypertension and arterial partial pressure of carbondioxide were higher in lung transplantation group than non-transplantation group (P<0.05). The 1-year survival rate in the lung transplantation group was significantly higher than that in the non-lung transplantation group: 77.4% vs. 32.7% (P<0.01). COX regression analysis showed that preoperative ventilator dependence, serum creatinine, bilirubin, pulmonary artery pressure, and procedures (single lung vs. double lung) had no significant effect on the prognosis of lung transplantation; age and preoperative diabetes mellitus were risk factors for the prognosis of lung transplantation.ConclusionsLung transplantation can significantly improve the prognosis of patients with ILD who are refractory to medicine therapy. IPF patients should be advised to consider lung transplantation as soon as possible. Age and preoperative diabetes mellitus are risk factors for the prognosis of lung transplantation.
Objective To summarize the clinical experience of harvesting the lung of a brain death donor by international standardized methods, so as to establ ish a set of standards and regulations appl icable for harvesting the lung of brain-death donors in China. Methods The operation was performed on 1 brain-death donor who had endured 50 hours of mechanical ventilation. The donor was assessed by donor lung function test and international brain death standard. Then the organ was perfused and trimmed ready for lung transplantation. Results We succeeded in harvesting the heart, lung, liver, kidney and cornea from this brain-death voluntary donor. The harvested lung was successfully transplanted into a recipient. And the recipient recovered well after operation. Conclusion The successful experience of harvesting the lung of the brain-death voluntary donor will contribute to the development and promotion of the utilization of brain-death donor suppl ies.
Objective To investigate the suppression effect and mechanism of Astilbin on lung allograft rejection in rats, in order to know the function of Astilbin on rats’ lung acute rejection. Methods The model of rat left lung transplantation was set up. Sixty lung transplanted rats were divided into two groups randomly, control group: rats were fed with normal saline 1ml per day, experimental group: rats were fed with Astilbin 1mg/kg per day. Survival time, transforming rate of T cells in spleen, activity of interleukin 2 (IL-2) in spleen lymph cells and apoptosis of T cells were observed. Changes in ultrastructure of pulmonary arteries were observed by electron microscope. Results The survival time in experimental group was prolonged than that in control group (25.4±2.1 d vs. 13.4±1.2 d;t=2.042, Plt;0.05）. Transforming rate of T cells of spleen in experimental group was significant lower than that in control group (23 465.8±8 783.4 cpm vs. 74 567.3±12 874.6 cpm; t=2.284，Plt;0.05）.Activity of IL-2 of spleen lymph cells in experimental group was significant lower than that in control group (425±2.65U/ml vs. 23.46±1.82U/ml; t=3.165, Plt;0.01).Effectively derive apoptosis of activated T cells in acute rejection were observed in experimental group, the ultrastructure of pulmonary arteries showed attenuated injury in experimental group. Conclusion Astilbin decreased the IL-2 concentration in plasma and induced the apoptosis in activated T cells, then suppressed the acute rejection of lung allograft and prolonged the survival period of lung transplantation rats.
The rehabilitation experience of 20 patients with tracheostomy after lung transplantation was reported, and the key points of rehabilitation nursing included sequential oxygen therapy, airway clearance, diaphragm pacing, respiratory training, swallowing training, speech training, exercise training, and gastrointestinal function rehabilitation. Tracheostomy is conducive to airway management and offline extubation in patients assisted by long-term breathing, and promotes patient recovery and discharge through multidisciplinary collaborative rehabilitation nursing integrated case management.
ObjectiveTo investigate the epidemiology, etiology and prognosis of pneumonia in lung transplantation recipients. MethodsWe retrospectively analyzed the follow-up data of 42 case times (40 patients) of allogenic lung transplantation between March 2005 and August 2014. There were 29 males and 11 females with a mean age of 52.4±13.8 years. There were 32 case times with double lung transplantation, and 10 case times with single lung transplantation. Two patients underwent lung transplantation twice at an interval of 6.5 years and 4.0 years, respectively. ResultsIn 42 case times of lung transplantation, 26 case times had forty-two episodes of pneumonia throughout the follow-up period of median 146 days (range 3 to 2 704 days). Microbiological etiology was established in 36 case times of pneumonia. Bacterial pneumonia (68.1%) was more frequent than fungal (10.6%) and viral pneumonia (8.5%). The cumulative risk of a pneumonia episode increased sharply in the first 30 days after transplantation. A percentage of 38.1% of total pneumonia episodes occurred within 30 days after transplantation, predominately due to Gram negative bacilli. While pneumonia of gram-negative bacilli occurred earliest with a median of 20 days (range 8-297 days). pneumonia caused by viruses (283 days, range 186-482 days) appeared significantly later than gram-negative bacilli, and unknown etiology (44.5 days, range 3-257 days) (P=0.001 and P=0.019, respectively). The survival rate in 1 year, 3 years, and 5 years was 66.1%, 56.3%, and 36.2%, respectively. pneumonia episode within 30 days after lung transplantation was associated remarkably with mortality risk (P=0.03) in lung transplantation recipients. The total blood loss during transplantation procedure and post-transplantation intubation time were associated significantly with early onset of pneumonia (≤30 days) by univariate analysis. ConclusionRecognition of epidemiology, etiology and chronology of post-transplantaion pneumonia has implications relevant for appropriate management and optimal antibiotic prescription in lung transplantation recipients.