Adnan SAYAR, Songül BÜYÜKKALE, Özgür İŞGÖRÜCÜ, Necati ÇITAK, Nur Dilek BAKAN

Akciğer naklinde güncel durum değerlendirmesi

Günümüzde akciğer nakli daha iyi uzun dönem sağkalım sonuçları ile son dönem akciğer parankiminin ve vasküler hastalıkların standart tedavi seçeneklerinden biri olarak kabul edilir. Akciğer nakli azalan sıklık sırası ile amfizem, kistik fibroz, pulmoner fibroz, pulmoner arteriyel hipertansiyon, bronşektazi, sarkoidoz, retransplant (obliteratif bronşiyolit) ve konnektif doku hastalığı gibi tedaviye yanıt vermeyen son dönem akciğer hastalıklarında sağkalım avantajı sağlayan bir tedavi yöntemi olmuştur. Kardiyak ve hemodinamik sistem desteklerindeki teknolojik ilerleme ve pulmoner vasküler fizyoloji ve immünsüpresif tedavideki gelişmelerle birlikte, akciğer naklinin erken dönem sağkalım oranları ilk üç ay ve 12 ay için sırasıyla %87 ve %78, uzun dönem sağkalım oranları ise üç, beş ve 10 yıl için sırasıyla %62, %50 ve %26 olarak hesaplanmıştır. En önemli sağkalım avantajı iki taraflı akciğer naklinde kronik obstrüktif akciğer hastalığı, alfa-1 antitripsin eksikliği ve kistik fibrozis hastalarında ve tek akciğer naklinde ise idiyopatik pulmoner fibrozis hastalarında tanımlanmıştır.

Assessment of current status in lung transplantation

Nowadays, lung transplantation is approved as one of the standardized treatments of end stage lung parenchymal and vascular diseases with superior long-term survival results. Lung transplantation has become a treatment method with survival advantage in end stage lung diseases which do not respond to treatment such as emphysema, cystic fibrosis, pulmonary fibrosis, pulmonary arterial hypertension, bronchiectasis, sarcoidosis, re-transplant (obliterative bronchiolitis), and connective tissue disease, with decreasing frequency order. Thanks to the technological progress in cardiac and hemodynamic system supports as well as the advancements in pulmonary vascular physiology and immunosuppressive treatment, early survival rates of lung transplantation for the first three and 12 months were calculated as 87% and 78%, respectively; while longterm survival rates for three, five, and 10 years were determined to be 62%, 50%, and 26%, respectively. Most significant survival advantage was reported in chronic obstructive pulmonary disease, alfa-1 antitrypsin deficiency, and cystic fibrosis patients in bilateral lung transplantation and in idiopathic pulmonary fibrosis patients in single lung transplantation.

PDF

___

Orens JB, Estenne M, Arcasoy S, Conte JV, Corris P, Egan JJ, et al. International guidelines for the selection of lung transplant candidates: 2006 update--a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006;25:745-55.
International guidelines for the selection of lung transplant candidates. The American Society for Transplant Physicians (ASTP)/American Thoracic Society (ATS)/European Respiratory Society (ERS)/International Society for Heart and Lung Transplantation (ISHLT). Am J Respir Crit Care Med 1998;158:335-9.
Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, et al. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2015;34:1-15.
Yusen RD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Dobbels F, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart-lung transplant report--2014; focus theme: retransplantation. J Heart Lung Transplant 2014;33:1009-24.
Verleden GM, Fisher AJ. Indication, patient selection and timing of referral for lung transplantation. Eur Respir Mon 2009;45:1-5.
Maurer JR, Frost AE, Estenne M, Higenbottam T, Glanville AR. International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society. J Heart Lung Transplant 1998;17:703-9.
Buyukkale S, Bakan ND, Isgorucu O, Citak N, Cenger D, Demir A, et al. First 24 lung transplantations: Single center results from Turkey. Eur Resp J 2014;44 (Suppl 58):P2450.
Inci I, Schuurmans MM, Boehler A, Weder W. Zurich University Hospital lung transplantation programme: update 2012. Swiss Med Wkly 2013;143:13836.
Bonser RS, Taylor R, Collett D, Thomas HL, Dark JH, Neuberger J. Effect of donor smoking on survival after lung transplantation: a cohort study of a prospective registry. Lancet 2012;380:747-55.
Angel LF, Levine DJ, Restrepo MI, Johnson S, Sako E, Carpenter A, et al. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes. Am J Respir Crit Care Med 2006;174:710-6.
Steen S, Sjöberg T, Pierre L, Liao Q, Eriksson L, Algotsson L. Transplantation of lungs from a non-heart-beating donor. Lancet 2001;357:825-9.
Aigner C, Slama A, Hötzenecker K, Scheed A, Urbanek B, Schmid W, et al. Clinical ex vivo lung perfusion--pushing the limits. Am J Transplant 2012;12:1839-47.
Nakajima D, Chen F, Yamada T, Sakamoto J, Ohsumi A, Bando T, et al. Reconditioning of lungs donated after circulatory death with normothermic ex vivo lung perfusion. J Heart Lung Transplant 2012;31:187-93.
Wierup P, Haraldsson A, Nilsson F, Pierre L, Scherstén H, Silverborn M, et al. Ex vivo evaluation of nonacceptable donor lungs. Ann Thorac Surg 2006;81:460-6.
Ingemansson R, Eyjolfsson A, Mared L, Pierre L, Algotsson L, Ekmehag B, et al. Clinical transplantation of initially rejected donor lungs after reconditioning ex vivo. Ann Thorac Surg 2009;87:255-60.
Tikkanen JM, Cypel M, Machuca TN, Azad S, Binnie M, Chow CW, et al. Functional outcomes and quality of life after normothermic ex vivo lung perfusion lung transplantation. J Heart Lung Transplant 2015;34:547-56.
Lang G, Taghavi S, Aigner C, Rényi-Vámos F, Jaksch P, Augustin V, et al. Primary lung transplantation after bridge with extracorporeal membrane oxygenation: a plea for a shift in our paradigms for indications. Transplantation 2012;93:729-36.
Bermudez CA, Shiose A, Esper SA, Shigemura N, D'Cunha J, Bhama JK, et al. Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation. Ann Thorac Surg 2014;98:1936-42.
Marasco SF, Than S, Keating D, Westall G, Whitford H, Snell G, et al. Cadaveric lobar lung transplantation: technical aspects. Ann Thorac Surg 2012;93:1836-42.
Keating DT, Marasco SF, Negri J, Esmore D, Burton JH, Griffiths AP, et al. Long-term outcomes of cadaveric lobar lung transplantation: helping to maximize resources. J Heart Lung Transplant 2010;29:439-44.
Aigner C, Winkler G, Jaksch P, Ankersmit J, Marta G, Taghavi S, et al. Size-reduced lung transplantation: an advanced operative strategy to alleviate donor organ shortage. Transplant Proc 2004;36:2801-5.
Date H, Sato M, Aoyama A, Yamada T, Mizota T, Kinoshita H, et al. Living-donor lobar lung transplantation provides similar survival to cadaveric lung transplantation even for very ill patients* . Eur J Cardiothorac Surg 2015;47:967-72.
Pasque MK, Cooper JD, Kaiser LR, Haydock DA, Triantafillou A, Trulock EP. Improved technique for bilateral lung transplantation: rationale and initial clinical experience. Ann Thorac Surg 1990;49:785-91.
Weder W, Inci I, Korom S, Kestenholz PB, Hillinger S, Eich C, et al. Airway complications after lung transplantation: risk factors, prevention and outcome. Eur J Cardiothorac Surg 2009;35:293-8.
Kroegel C, Hekmat K, Möser A, Happe J, Walther R, Reissig A. Airway complications following lung transplantation- clinic, diagnosis, and interventional management. Pneumologie 2011;65:293-307. [Abstract]
Jiang X, Malkovskiy AV, Tian W, Sung YK, Sun W, Hsu JL, et al. Promotion of airway anastomotic microvascular regeneration and alleviation of airway ischemia by deferoxamine nanoparticles. Biomaterials 2014;35:803-13.
Currey J, Pilcher DV, Davies A, Scheinkestel C, Botti M, Bailey M, et al. Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant. J Thorac Cardiovasc Surg 2010;139:154-61.
McIlroy DR, Pilcher DV, Snell GI. Does anaesthetic management affect early outcomes after lung transplant? An exploratory analysis. Br J Anaesth 2009;102:506-14.
Biscotti M, Sonett J, Bacchetta M. ECMO as bridge to lung transplant. Thorac Surg Clin 2015;25:17-25.
Toyoda Y, Bhama JK, Shigemura N, Zaldonis D, Pilewski J, Crespo M, et al. Efficacy of extracorporeal membrane oxygenation as a bridge to lung transplantation. J Thorac Cardiovasc Surg 2013;145:1065-70.
Lafarge M, Mordant P, Thabut G, Brouchet L, Falcoz PE, Haloun A, et al. Experience of extracorporeal membrane oxygenation as a bridge to lung transplantation in France. J Heart Lung Transplant 2013;32:905-13.
Hoopes CW, Kukreja J, Golden J, Davenport DL, Diaz- Guzman E, Zwischenberger JB. Extracorporeal membrane oxygenation as a bridge to pulmonary transplantation. J Thorac Cardiovasc Surg 2013;145:862-7.
Woodrow JP, Shlobin OA, Barnett SD, Burton N, Nathan SD. Comparison of bronchiolitis obliterans syndrome to other forms of chronic lung allograft dysfunction after lung transplantation. J Heart Lung Transplant 2010;29:1159-64.
Sato M, Waddell TK, Wagnetz U, Roberts HC, Hwang DM, Haroon A, et al. Restrictive allograft syndrome (RAS): a novel form of chronic lung allograft dysfunction. J Heart Lung Transplant 2011;30:735-42.
Trulock EP, Christie JD, Edwards LB, Boucek MM, Aurora P, Taylor DO, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult lung and heart-lung transplantation report-2007. J Heart Lung Transplant 2007;26:782-95.
Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003;349:931-40.
Schuurmans MM, Benden C, Inci I. Practical approach to early postoperative management of lung transplant recipients. Swiss Med Wkly 2013;143:13773.