在外科手术后期的主要移植功能障碍预防策略
Jérémie Guillemin1,2,3, Michael Cutrone4, Suraj Yalamuri5
1Adult Cardiothoracic Anesthesiology, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France.
JHLT open
|December 8, 2025
概括
心脏和肺移植后预防初级移植功能障碍 (PGD) 涉及优化捐赠者和接受者,改善器官保存,并采用先进的输液技术. 新兴的机器输液技术在减少PGD和提高移植结果方面显示出希望.
科学领域:
- 心脏病学 心脏病学
- 胸部外科手术 胸部外科手术
- 移植免疫学 移植免疫学
背景情况:
- 主要移植功能障碍 (PGD) 是心脏和肺移植后早期死亡和疾病的主要原因.
- 它源于复杂的因素,包括缺血-再输液损伤,炎症,免疫反应和供体/受体特征.
- 在短期和长期的移植成功中,PGD都有显著的影响.
研究的目的:
- 审查目前的证据和指导方针,以预防心脏和肺移植中的PGD.
- 突出用于PGD风险降低的外科手术期间的战略.
主要方法:
- 叙事综述综合了国际心脏和肺移植学会 (ISHLT) 和最近的临床研究的证据.
- 专注于捐赠者/接受者优化,器官保存,手术内管理和 perfusion 技术.
主要成果:
- 心脏移植:阿米奥达龙暴露和捐赠者-接受者不匹配增加了PGD风险. 低温氧化输液和正常热活体输液显示有好处.
- 肺移植:低的德克斯溶液和活体肺输液与较低的PGD率有关. 外技术或ECMO可能会减少PGD.
- 优化保存和植入技术至关重要.
结论:
- 移植过程的每一个阶段对于最小化PGD风险至关重要.
- 机器输液技术为改善移植利用,减少PGD和改善移植结果提供了一个有前途的途径.
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