摘要:

Purpose:The clinical success of human lung transplantation is limited by the development of bronchiolitis obliterans syndrome, a pulmonary specific manifestation of chronic allograft rejection. Although the etiology of bronchiolitis obliterans syndrome is not well understood, there is increasing evidence for a role of antibody to human leukocyte antigens in the development of this condition. This review critically evaluates recent publications that have investigated the clinical significance of anti human leukocyte antigen antibody in lung transplant recipients.Recent findings:A striking association has been observed between the development of antibody to donor human leukocyte antigen and bronchiolitis obliterans syndrome in some lung transplant patients. Indirect presentation of donor human leukocyte antigen may be critical to the development of anti human leukocyte antigen antibody. In human airway epithelia culturedin vitro,anti human leukocyte antigen antibody‐ligand interactions induce fibroproliferative and apoptotic responses, implying a mechanistic role for antibody in the development of bronchiolitis obliterans syndrome.Summary:The response to allogenic solid organ transplant appears complex, involving both cellular and humoral components. Emerging evidence supports a pathogenic role for antibody to donor human leukocyte antigen in the development of chronic lung transplant rejection. Additional research is needed to better understand mechanisms of antibody production, further describe cellular effects of antibody‐ligand interactions, and, importantly, explain why anti human leukocyte antigen antibody is detectable in only a subset of patients with bronchiolitis obliterans syndrome.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Rationale:The role of transbronchial lung biopsy after lung transplantation has been questioned. Supporters favor the diagnostic precision afforded by repeated histopathological examination of the allograft and point to a satisfactory risk‐benefit ratio in experienced hands. The contrary viewpoint emphasizes a lack of cost efficiency for surveillance biopsies versus clinically mandated studies. This review therefore examines the evidence supporting each case and provides a background to allow an understanding of the history of this invasive diagnostic test. The special role of follow‐up biopsies to assess the impact of targeted therapies and to chronicle the natural history of untreated “minor” rejection events is then examined critically.Recent findings:The proposed simple nexus between biopsy‐proven acute pulmonary allograft rejection and the development of obliterative bronchiolitis is now understood to be more complex. Recent studies of large numbers of recipients followed with surveillance and clinically mandated transbronchial biopsies for sufficient time periods to develop a robust assessment of outcomes now support the concept that allograft rejection should be viewed as a continuum rather than a discrete series of high grade events and hence that it is the time‐weighted sum of rejection that is important. A similar concept for infective events also has support.Summary:While the individual risk‐benefit ratio must dictate the performance (or not) of transbronchial biopsy in a particular patient, the accumulating data now support early surveillance procedures with follow‐up studies to assess resolution of events and to detect adverse outcomes of therapies.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Lung transplantation is now considered to be a therapeutic option for patients with end‐stage lung diseases. Unfortunately, because of the problems of lung allograft rejection, it is only a treatment and not a cure. Critical to the continuum of acute to chronic (bronchiolitis obliterans syndrome) lung allograft rejection is persistent allorecognition with T‐cell activation by costimulatory molecules leading to the expression of cytokines, chemokines, and growth factors. These events establish a persistent recruitment of peri‐airway/vascular alloreactive leukocytes that eventually cause an aberrant reparative process. The aberrant repair process involves the recruitment and proliferation of leukocytes and mesenchymal cells, ultimately resulting in lung dysfunction in the form of fibro‐obliteration. Studies involving patients with bronchiolitis obliterans syndrome and translational studies using animal models have demonstrated the expression of cytokines, chemokines, and growth factors all play specific roles in pathogenesis of bronchiolitis obliterans syndrome. In this review, we will discuss the role of cytokines in mediating the pathogenesis of bronchiolitis obliterans syndrome.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Survival and allograft function in lung transplant recipients are limited by the development of bronchiolitis obliterans. The precise pathogenesis of bronchiolitis obliterans remains unknown. However, studies indicate that epithelial injury in the lung allograft can be induced by a variety of factors, including infections. Indeed, infection is among the most significant complications in lung transplant recipients, and some infectious agents are recognized to trigger allograft injury. Cytomegalovirus is an immunomodulating herpesvirus that causes an upregulation of human leukocyte antigen class I and intracellular adhesion molecule I in the epithelial cells of the lung allograft, resulting in activation of T helper and cytotoxic T cells. Respiratory viruses activate inflammatory mechanisms in the transplant lung that may lead to acute allograft rejection during and after respiratory viral infections. More importantly, data show the development of bronchiolitis obliterans after infection with these common pathogens. This review examines the published data implicating viruses and other infectious pathogens in the development of bronchiolitis obliterans in lung transplant recipients.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Anesthesiologists will be caring for more transplant recipients in the foreseeable future. This is because of improvements in transplantation techniques and in the management of diabetes and renal disease. The cardiovascular comorbidity associated with both renal and pancreas recipients is truly a common denominator in the assessment and perioperative care of these patients. This review briefly describes new findings in the pathophysiology of the renal and pancreas transplant recipient population. It also covers several topics germane to anesthesiologists including preoperative assessment and concerns, intraoperative management and outcomes following transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Lung transplantation is one of the most challenging operations an anesthesiologist can face. The patient's condition in the preoperative state is often rather tenuous. Pulmonary hypertension either exists preoperatively or can easily occur intraoperatively. Despite improvements in preservation techniques, reperfusion injury of the donor lung remains an issue. The anesthesiologist must attempt to minimize any rise in pulmonary artery pressures through the use of intravenous agents or inhaled nitric oxide and judicious fluid administration. Prophylactic attempts to minimize reperfusion injury must also be undertaken.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Liver failure is a deadly disease for which transplantation is the only cure until liver cell cultures become feasible. Over the past two decades, liver transplant surgery has gained popularity in many countries around the globe.The survival of the transplanted organ depends greatly on the ability of the anesthesiologist to maintain its viability. Therefore, it became of great importance to understand facts and factors that affect the survival of the grafted organ. Hemodynamics, nitrous oxide, and cytokines are a few among the multitude of other factors that need to be understood.Despite of the advancement in anesthesia that made this surgery possible, anesthetic literature is still scarce, and the field remains wide open for further research.

ISSN:1087-2418    

出版商:OVID    

年代:2003

数据来源: OVID