Objective To establish a simple, valid rat orthotopic left lung transplantation model with the improved operation technique. Methods One hundred and thirty-six male SD rats were randomly divided into donor （n = 68） and recipient （n = 68）, transplantation were performed by using the improved cuff anastomosis technique. Results Time of donor lung perfusion-picking, donor lung vessel cuff anastomosis and recipient vessel anastomosis was 13±2 min, 9±1 min, 10±1 min respectively, the operative time was 60±3 min. In 68 rats of operations, successful rate was 88%（60/68）, anastomotic stoma leak in one rat, lung congestion 3 rats, lung atelectasis 4 rats. The shortest survival time was 1 day, there were 53 rats whose survival time was longer than 12 days. The chest computed tomography showed no atelectasis and blood gas analysis manifested good respiratory function. Conclusion The improved three cuff anastomosis technique offers a simple, valid, cheap and useful method,it can establish rat orthotopic left lung transplantation model successfully.
With the deepening of current study and the innovation of perioperative management concept, there have been great advances in lung transplantation in recent years. The prognosis of patients has been significantly improved. At the same time, the role of various types of blood purification in the clinical monitoring and treatment of lung transplant patients is becoming increasingly prominent. This review aims to summarize the application and latest progress of in vitro blood purification such as renal replacement therapy, plasmapheresis and hemadsorption in the perioperative period of lung transplantation, and to provide a basis for further study.
Objective To explore the hemodynamic monitoring value of pulse-indicated continuous cardiac output( PiCCO) during lung transplantation. Methods Twenty patients with end-stage lung disease undergone lung transplantation were enrolled. Hemodynamic states were monitored by PiCCO and Swan-Ganz standard thermodilution pulmonary artery catheter( PAC) simultaneously at six stages throughout the study. Changes in the variables were calculated by subtracting the first fromthe second measurement( Δ1 ) and so on ( Δ1 to Δ5 ) . Results The linear correlation between intra-thoracic blood volume index( ITBVI) and stroke volume index( SVIpa) was significant ( r = 0. 654, P lt; 0. 05) , whereas pulmonary artery wedge pressure ( PAWP) poorly correlated with SVIpa( P gt; 0. 05) . Changes in ITBVI correlated with changes in SVIpa ( Δ1 , r =0. 621; Δ2 , r = 0. 784; Δ3 , r = 0. 713; Δ4 , r = 0. 740; Δ5 , r = 0. 747; all P lt; 0. 05) , whereas PAWP failed. The mean bias between CIart and CIpa was ( 0. 09 ±0. 5) L·min-1 ·m-2 ; the limit of agreement was ( - 0. 89 ～1. 07) L·min-1 ·m-2 . Conclusions There is good correlation between the two methods of PiCCO and PAC for reflecting the change of heart preload. PiCCO is reliable in hemodynamic monitoring in patients undergone lung transplantation.
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.
ObjectiveProlonged mechanical ventilation (PMV) is a prognostic marker for short-term adverse outcomes in patients after lung transplantation.The risk of prolonged mechanical ventilation after lung transplantation is still not clear. The study to identify the risk factors of prolonged mechanical ventilation (PMV) after lung transplantation.Methods This retrospective observational study recruited patients who underwent lung transplantation in Wuxi People’s Hospital from January 2020 to December 2022. Relevant information was collected from patients and donors, including recipient data (gender, age, BMI, blood type, comorbidities), donor data (age, BMI, time of endotracheal intubation, oxygenation index, history of smoking, and any comorbidity with multidrug-resistant bacterial infections), and surgical data (surgical mode, incision type, operation time, cold ischemia time of the donor lung, intraoperative bleeding, and ECMO support), and postoperative data (multi-resistant bacterial lung infection, multi-resistant bacterial bloodstream infection, and mean arterial pressure on postoperative admission to the monitoring unit). Patients with a duration of mechanical ventilation ≤72 hours were allocated to the non-prolonged mechanical ventilation group, and patients with a duration of mechanical ventilation>72 hours were allocated to the prolonged mechanical ventilation group. LASSO regression analysis was applied to screen risk factors., and a clinical prediction model for the risk of prolonged mechanical ventilation after lung.ResultsPatients who met the inclusion criteria were divided into the training set and the validation set. There were 307 cases in the training set group and 138 cases in the validation set group. The basic characteristics of the training set and the validation set were compared. There were statistically significant differences in the recipient’s BMI, donor’s gender, CRKP of the donor lung swab, whether the recipient had pulmonary infection before the operation, the type of transplantation, the cold ischemia time of the donor lung, whether ECMO was used during the operation, the duration of ECMO assistance, CRKP of sputum, and the CRE index of the recipient's anal test (P<0.05). 2. The results of the multivariate logistic regression model showed that female recipients, preoperative mechanical ventilation in recipients, preoperative pulmonary infection in recipients, intraoperative application of ECMO, and the detection of multi-drug resistant Acinetobacter baumannii, multi-drug resistant Klebsiella pneumoniae and maltoclomonas aeruginosa in postoperative sputum were independent risk factors for prolonged mechanical ventilation after lung transplantation. The AUC of the clinical prediction model in the training set and the validation set was 0.838 and 0.828 respectively, suggesting that the prediction model has good discrimination. In the decision curves of the training set and the validation set, the threshold probabilities of the curves in the range of 0.05-0.98 and 0.02-0.85 were higher than the two extreme lines, indicating that the model has certain clinical validity.ConclusionsFemale patients, Preoperative pulmonary infection, preoperative mechanical ventilation,blood type B, blood type O, application of ECMO assistance, multi-resistant Acinetobacter baumannii infection, multi-resistant Klebsiella pneumoniae infection, and multi-resistant Stenotrophomonas maltophilia infection are independent risk factors for PMV (prolonged mechanical ventilation) after lung transplantation.
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.
Lung transplantation has been proved to be an effective treatment after more than forty years of fast development, while more than 4000 cases of lung transplantation performed globally each year. Recently, lung transplantation in China has been advanced rapidly, and the number of transplants has increased year by year. Respiratory and Critical Care Medicine team has been recognized to play a crucial role in lung transplantation. It has an irreplaceable role and status in promoting lung transplantation, improving the preoperative evaluation of lung transplantation and the maintenance of donors, and carrying out perioperative management, as well as long-term follow-up. Lung transplantation is a systematic project, requiring the perfect cooperation and collaboration of team members and contributing to recipients’ recovery.
Objective To examine the effect of endothelial progenitor cell (EPC) on lung ischemia-reperfusion injury (LIRI). Methods Twenty-four recipients were randomized into 3 groups including a sham group, a LIRI group, and an EPC group. Rats in the sham group only received anesthesia. Rats in the LIRI and EPC groups received left lung transplantation and received saline or EPC immediately after reperfusion. The partial pressure of oxygen to fraction of inspiratory oxygen (PaO2/FiO2) ratio, wet-to-dry weight ratio and protein levels in the transplanted lung and inflammation-related factors levels in serum were examined. Histological change of transplanted lung were analyzed. The nuclear factor (NF)-κB in the transplanted lung was detected. Results Compared with the LIRI group, the PaO2/FiO2 ratio dramaticly increased, and the wet-to-dry weight ratio and protein level significantly decreased by EPC after reperfusion. The lung histological injury was attenuated by EPC. The pro-inflammatory factors in serum were down-regulated, whereas IL-10 was up-regulated in the EPC group. The expression of NF-κB was decreased by EPC. Conclusion EPC ameliorated LIRI after lung transplantation. The protection of EPC partly associated with anti-inflammation.
The quality control of lung transplantation involves many aspects, such as team building, selection of recipients, preoperative diagnosis and evaluation of recipients, maintenance of brain-dead donors, evaluation and acquisition of donors, surgical operation, postoperative management and postoperative follow-up. Precision management is the core concept of operation quality control. Only by normalizing the operation quality control of lung transplantation to provide basic guarantee for multi-team cooperation and development of lung transplantation management in the future, building a complete lung transplantation database to excavate data resources and improve the quality of transplantation, and comprehensively building a Chinese lung transplantation quality control system with multi-team participation and cooperation, can we improve the overall level of surgical diagnosis and treatment of lung transplantation in China.
[Abstract]It is an effective way of constructing a lung transplantation quality control system suitable for China's national conditions to break through the many dilemmas in China. Under the leadership of the National Quality Control Center, a stage-by-stage and full-scale quality control system for lung transplantation in China has been gradually constructed and extended to many lung transplantation centers nationwide, which has strongly promoted the development of lung transplantation in China. This article outlines the construction, promotion and experience of China's lung transplantation quality control system, aiming to provide reference for further development of relevant measures to promote the homogenization of lung transplantation in China.