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1、肺移植国内外进展,Lung Transplant History,First experimental operation: 1950-54 Metras, HardinFirst human operation: 1963 Hardy Recipient:58-yr-old man, emphysema Donor: MI, shock - ER left single lung Tx,Background ：Lung Transplantation,Background ：Lung Transplantation,1st Success,1983 - Toronto Lung Transp
2、lant Group58 yr old male, IPFSurvived 7 yearsDied of kidney failure caused by anti-rejection medication,Background ：Lung Transplantation,En Bloc Double Lung,Dark (1986) experimental technique (canine)1986 Patterson et al. - first successful en bloc double lung transplant (Alive today)Donor airway is
3、chemia still a problem,Background ：Lung Transplantation,Sequential Double Lung,Pasque et al. Wash U. Bilateral sequential lung transplantation emerged in 1989 May avoid CPB. No need for cardioplegiaReduced bronchial anastomotic problems,Background ：Lung Transplantation,Living-donor lobar lung transp
4、lantation was introduced by Starnes and colleagues in 1991,Recipient (son) PPH Donor (mother) right lower lobe,Background ：Lung Transplantation,The Registry of the International Society for Heart andLung Transplantation: Twenty-seventh ofcial adult lungand heart-lung transplant report,ISHLT,2010,Bac
5、kground ：Lung Transplantation,NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE,ISHLT,NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants
6、performed worldwide.,2010,ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2008),ISHLT,2010,ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2009),ISHLT,2010,ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year,ISHLT,2010,ADULT LUNG TRANSPLANTATIONKap
7、lan-Meier survival by diagnosis (Transplants: January 1988 June 2008),ISHLT,2010,ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2009),ISHLT,2010,Donor Lung,Flushing to removeblood, preservationQuestions:Tm, Time, solutioninflation?,TransplantationQuestion:How to do the
8、operation,ReperfusionQuestions:Rate, pressure,ventilation, etc,Transport from A to B,Barriers to Success,shortage of donors waiting list mortalityPGDacute rejection BOS.,NovaLungBridge to Lung Transplantation,NovaLung,Deceased Donors,Current largest, best source of donor lungsWe have NOT maximized u
9、tilizationNeed to improve utilization:Manage donors betterDevelop better strategies to predict post transplant lung functionStrategies to assess lungs (ex-vivo)Strategies to “repair” donor lungs,Donor Lung,Physiologic Assessment,Excellent,Biologic Assessment,Excellent,TRANSPLANT,Fails,Ex-vivo Assess
10、ment and Treatment,DONOR LUNG,Physiologic Assessment,Excellent,Biologic Assessment,Excellent,TRANSPLANT,Fails,Ex-vivo Assessment and Treatment,Fails,Gene Therapy, Other Repair Strategies,Reassess,Fails,No Transplant,Lung Transplantation in China,First stage 1978 Dr.Xing Yu-ling , first SLTx for TB i
11、n China, died 1995 Dr. Chen Yu-ping SLTx for IPF survived 1998 Dr. Chen Yu-ping BLTx for PPH with CPB urvived,1978 Dr.Xing Yu-ling first SLTx for TB in China,Dr. Chen Yu-ping 1995-2-23, SLTx for IPF survived 5y10m 1998-1-20, BLTx for PPH with CPB, survived 4y3m,Background ：Lung Transplantation,From
12、1994 to 1998 , about 20 cases were performed, only 2 patients survived.The LTx stoped in China from 1998-Sep.2002 because of low survival rate.,Second stage Since the SLTx for COPD was performed by Wuxi Group on Sep. 2002, remarkable progress have be achieved in China.,器官移植学会登记处各种器官移植统计,*数据主要来源于各移植数
13、据中心,Number of lung transplants in China (1978-2010),本中心,Result,1，2，3 , 5 year survive rate is 73.3%,61.6%,53.5%,40.7%.,Insision consideration,Bilateral anterolateral thoracotomiesClamshell incision (trans-sternal Bilateral thoracotomy incision)Antero muscle sparing thoractomyMinimally invasive techn
14、ique with VATS,Insision consideration,Insision consideration,Insision consideration,Operative technique,Bronchial anastomosisArterial anastomosisLeft atrium anastomosis Size discrepancies Unusual circumstance,Operative technique,Operative technique,Pulmonary Artery Anastomosis,Operative technique,Le
15、ft Atrial Anastomosis,术后病理,术后病理,BSLTx 1st, March 2005,5.Ventilator dependent recipient,Preoperative chest roentgenogram of a 49-year man with COPD. 1.68cm , 46kg, BMI 73 % Preoperation depended on ventilator for 107 days.,BLT without sternal division,12. Male,46y,BAC BLTx,单肺移植同期心内缺损修补治疗艾森曼格综合征,男性，16
16、岁，先天性心脏病室间隔缺损心内直视探查术后，术前肺动脉压力110/60mmHg（Pp/Ps 1.0），静息紫绀4年，活动耐力明显减低，于2004年10月22日在全麻低温体外循环下行室缺修补、同期右侧单肺移植术。术中体外循环时间244分钟，供肺冷缺血时间6小时，术后FK506、MMF、激素三联免疫抑制治疗。,术后三天内移植肺出现中等度再植反应性肺水肿，术后7天气管切开，12天撤离呼吸机；术后14天出现急性排斥1次，治疗后缓解。术后肺动脉压力53/39mmHg（Pp/Ps 0.57）。,术后30天胸片及胸部CT显示右移植肺清晰，肺通气血流灌注扫描示右侧移植肺血流占90%， UCG示左室内径较术前缩
17、小17%，室缺修补完整无残余分流，术后活动耐力明显改善，62天出院。术后随访已有5近年，生活质量良好。,16 F，PPH, BLT with ECMO,移植前后心超结果比较（术前及术后2.5月）,http:/,国际标准化脑死亡供肺的获取及应用(附3例报告),南京医科大学附属无锡市人民医院肺移植中心陈静瑜,资料与方法,供 体 资 料,资料与方法,供 体 资 料,家属与脑死亡供体告别,供体肺手术方法,资料与方法,供体获取团队在术前祷告,供体肺手术方法,资料与方法,国际标准化脑死亡供肺的获取及应用,受 体 资 料,Transplant for late stage of Pneumosilicosis,主办国家级继续教育项目5项( 2004-2010年)全国第一至第五届心肺移植会议,THANKS,
