摘要:

Despite the short-term success of heart transplantation, chronic rejection, or cardiac allograft vasculopathy (CAV), remains the leading cause of allograft failure after the 1st posttransplant year. CAV is a diffuse concentric form of coronary atherosclerosis that occurs in 40 to 50% of heart transplant recipients within 5 years. CAV causes progressive obstruction of the coronary arteries, precipitating ischemic heart failure and sudden death. The mechanism of CAV is not completely defined but involves immune and nonimmune factors. The diagnosis of CAV remains challenging despite greater use of intravascular ultrasound. Unfortunately, no current medical regimen can reverse or completely prevent CAV. The effectiveness of revascularization procedures (angioplasty, stents, or bypass surgery) in CAV is severely limited by disease recurrence. Retransplantation also presents an ethical dilemma in the context of the donor organ shortage. Research directed at elucidating the mechanism of chronic rejection is needed to develop novel management options for CAV.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The concept of ventricular assistance as a bridge to recovery of cardiac function has received a great deal of recent attention because of its enormous potential for offering an alternative mode of therapy for an ever-growing list of patients with end-stage heart disease. Although there are clear rationales for the anatomic, histologic, and biochemical alterations facilitated by ventricular support, there has yet to be large-volume predictable clinical success with this concept. Nonetheless, increased awareness of this possibility has led to the development of protocols for patient evaluation and treatment that will lead to increased future successes. Augmented bridges to recovery, such as with proangiogenic therapy or cell transplantation, may be developed as realistic options. An effort to test these hypotheses with approved devices in the bridge-to-transplant population must be developed for this goal to be realized.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Although therapies for heart disease continue to improve life expectancy, mortality remains high for those with end-stage heart disease despite aggressive medical treatment. The goal of transplantation is to improve survival in this difficult group of patients. Recent data show 1-, 3-, and 5-year posttransplant survival rates at 85.5%, 76.9%, and 69.6%, respectively. During the past decade, efforts have been made to expand the donor pool by increasing public awareness regarding organ donation and expanding criteria for donor acceptance. Transplant centers have become more restrictive in transplant candidate selection during this period, and the number of new registrations has decreased in the past 5 years. Despite these efforts, the supply–demand mismatch persists. As the number of those awaiting transplantation grows, so too have the number of transplants performed on an urgent basis. Three quarters of the organs allocated in 1988 to 1999 went to high-priority patients, whereas about half the transplants performed in 1995 were considered urgent. Despite this shift in patient acuity, outcomes have remained stable during the past decade. This stability is probably the result of the growing expertise in caring for these critically ill patients and to improved immunosuppression.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

During the past decade, refinements in lung preservation techniques have significantly increased organ availability and sharing; however, severe reperfusion injury still occurs in a significant proportion of patients after lung transplantation, and evidence suggests that it may lead to a higher rate of acute rejection and graft dysfunction in the long term. We review the mechanisms of ischemia–reperfusion and strategies to minimize injury during lung transplantation in clinical practice. Future therapeutic strategies are also highlighted.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Obliterative bronchiolitis remains a limiting factor for long-term survival in lung transplant recipients. Although current immunosuppression regimens are suboptimal, progress has been made with the development of newer agents, including the interleukin-2 receptor antagonists. Prevention and management of acute rejection and cytomegalovirus infection may impact the onset, survival, and outcomes of patients with obliterative bronchiolitis. Ultimately, research on chimerism and the development of tolerance hold the key to long-term graft survival.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Cytomegalovirus (CMV) is a common pathogen after lung transplantation; however, in spite of diagnostic and therapeutic advances, CMV remains associated with significant morbidity and mortality in lung transplant recipients. Therefore, it is not only important to manage CMV but to prevent its occurrence. The patients at highest risk of developing CMV disease are seronegative recipients of seropositive donors and seropositive recipients who receive augmentation of their immunosuppressive regimens for induction or for treatment of rejection episodes. Methods for early diagnosis and monitoring of CMV in lung transplant recipients include CMV cultures, the antigenemia test, and the polymerase chain reaction assays. In addition, two modalities have emerged to prevent CMV disease in lung transplant recipients: universal prophylaxis and pre-emptive therapy. This review summarizes our current knowledge of the early diagnosis and prevention of CMV disease in lung transplant recipients.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

During the past 15 years, single lung transplantation and bilateral sequential lung transplantation have become effective management options for chronic pulmonary failure of varying cause. Fueled by the scarcity of pulmonary allografts, the increasing number of patients requiring lung transplantation, and a desire to help the greatest number patients, lung transplant centers have been scrutinizing their use of bilateral versus single lung transplants. This article reviews the recent and historic literature on the appropriate indications for both procedures.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Lung transplantation has become a well-established management for many end-stage pulmonary diseases; however, the same success has not been achieved as with other solid organ transplants. Despite substantial improvements in organ preservation and the perioperative management of lung transplant recipients, ischemia–reperfusion injury, acute rejection, and chronic rejection persist. Severe ischemia–reperfusion injury affects as many as 20% of lung transplant recipients, prolongs mechanical ventilation, and may result in hemodynamic compromise. Acute rejection is the most common risk factor for bronchiolitis obliterans, a manifestation of chronic graft rejection, which ultimately progresses to graft failure. Gene therapy is a promising therapeutic option for these transplant-related injuries. Potential targets include donor and recipient, with a host of available delivery options and gene constructs. This review addresses the challenges of gene therapy and reviews its experimental progress in lung transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The disparity between the number of donor lungs and the number of people awaiting transplantation continues to grow. The increasing number of patients dying while on the waiting list has led the transplant community to evaluate new strategies to improve organ procurement and distribution. Increasing public and health care staff awareness about transplantation, improving the consent process, using marginal and non–heart-beating donors, and improving the efficiency of the procurement process may help expand the lung donor pool. Although controversial, changes to the current lung allocation process that will take into account a patient's medical urgency may help decrease the number of patients that die while awaiting transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2001

数据来源: OVID