优化肺移植前候选者。

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-07 DOI:10.1097/MOT.0000000000001116
John Pagteilan, Scott Atay
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引用次数: 0

摘要

综述目的:肺移植的结果受到多种可改变的危险因素的影响。候选人在等待名单上的恶化仍然是个问题。识别和影响移植前发病率的创新技术和策略改善了短期和长期结果。我们重点回顾了在转运前受体评估和优化方面的最新进展。最近的发现:受体管理的进展集中在不良结果的风险因素识别和肺移植特异性虚弱评估的发展上。胃食管反流病(GERD)的早期手术矫正,包括在食管运动障碍的情况下使用部分胃底折叠术,可以改善移植物的功能/寿命。新的证据支持扩大体外生命支持作为移植桥梁的标准。总结:候选优化需要早期干预,以限制可能导致不良结果的功能恶化。虚弱可以通过移植特异性虚弱评估来识别,并通过专门的康复来产生积极影响。移植前的虚弱在移植后是可逆的,在选择候选人时应考虑整体健康状况。包括体外膜肺氧合(ECMO)在内的有创支持模式适用于保持力量和机动性,优选清醒、动态ECMO。胃食管反流术对移植物功能的有害影响可以通过早期胃底折叠术来控制,而不是单独进行药物治疗。
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Optimizing the prelung transplant candidate.

Purpose of review: Lung transplant outcomes are impacted by multiple modifiable risk factors. Candidate deterioration on the wait list remains problematic. Innovative technology and strategies to identify and impact pretransplant morbidity have improved short- and long-term outcomes. We focus our review on recent advances in pretransplant recipient assessment and optimization.

Recent findings: Advancements in recipient management have focused on risk factor identification for adverse outcomes and the development of a lung transplant specific frailty assessment. Early surgical correction of gastroesophageal reflux disease (GERD), including the use of partial fundoplication in the setting of esophageal dysmotility, leads to improvements in graft function/longevity. New evidence supports expanding criteria for extracorporeal life support as a bridge to transplant.

Summary: Candidate optimization requires early intervention to limit functional deterioration potentially contributing to adverse outcomes. Frailty can be identified with a transplant specific frailty assessment, and positively impacted with dedicated rehabilitation. Pretransplant frailty is reversible following transplant and should be considered in the context of overall fitness at the time of candidate selection. Invasive support modes including extracorporeal membrane oxygenation (ECMO) are appropriate to preserve strength and mobility, with awake, ambulatory ECMO preferred. The deleterious effect of GERD on graft function can be managed with early fundoplication over medical management alone.

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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
期刊最新文献
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