IMAGING OF LUNG TRANSPLANTATION - 08/09/11
Résumé |
The first human lung transplantation was performed in 1963 but was unsuccessful. When cyclosporine was introduced in the early 1980s, the era of solid organ transplantation began. The first long-term success with human single lung transplantation, which was modeled on the concepts established for heart–lung transplantation at Stanford University, occurred in 1983 at the Toronto General Hospital. In 1986, the technique for double lung transplantation was successfully developed. The field of lung transplantation has evolved dramatically in the past 16 years. 2, 15, 21, 26, 32, 37, 50, 52, 53, 70, 72 One-year survival after lung transplantation is now 80% to 90% and 5-year survival is approximately 50%.21 The operative mortality rate is less than 10%. Lung transplantation is now an accepted treatment for a large number of end-stage pulmonary diseases, including, but not limited to, emphysema, cystic fibrosis, pulmonary fibrosis, sarcoidosis, lymphangioleiomyomatosis, and primary pulmonary hypertension.
Several factors have led to the ultimate success of lung transplantation, including (1) improved recipient assessment and selection, (2) improved intensive care unit care, (3) better understanding of the mechanism of rejection and refinements in immunosuppressive regimens, (4) improved prevention, diagnosis, and treatment of infections, (5) improved surgical techniques to overcome problems of airway ischemia, and (6) development of effective rehabilitation programs.
Major challenges remain, however. 18, 19 The major obstacle to the growth of lung transplant programs is the limited supply of suitable donors. Only 20% to 30% of multi-organ donors have lungs that are suitable for transplantation because of the high incidence of complications such as aspiration pneumonia, atelectasis, and the pulmonary edema associated with donor brain death. More recently, the harvest of lower lobes from two living donors for double lung transplant has been performed successfully by several groups, thereby shortening the wait for a suitable donor.67 The development of obliterative bronchiolitis in up to 50% of long-term survivors remains another major challenge. Obliterative bronchiolitis is the major factor affecting long-term survival and quality of life. 32, 35
Several complications pertain specifically to lung transplant recipients, including airway ischemia, reperfusion edema, infections, acute rejection, obliterative bronchiolitis and other postoperative problems related to surgical technique and immunosuppressive therapy. Imaging procedures play an important role in the diagnosis and management of these problems. This article focuses on the imaging appearance of these complications.*
Le texte complet de cet article est disponible en PDF.Plan
| Address reprint requests to Jo-Anne O. Shepard, MD, Department of Radiology–FND 202, Massachusetts General Hospital, Boston, MA 02114 |
Vol 20 - N° 4
P. 827-844 - décembre 1999 Retour au numéro
Article précédent
- INTERVENTIONAL TECHNIQUES IN THE THORAX
- Jeffrey S. Klein
- RADIOLOGIC EVALUATION OF EMPHYSEMA FOR LUNG VOLUME REDUCTION SURGERY
- Ella A. Kazerooni
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?