Alterations in Pulmonary Physiology with Lung Transplantation.
IF 4.2
2区 医学
Q1 PHYSIOLOGY
Manish Mohanka, Amit Banga
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Abstract
Lung transplant is a treatment option for patients with end-stage lung diseases; however, survival outcomes continue to be inferior when compared to other solid organs. We review the several anatomic and physiologic changes that result from lung transplantation surgery, and their role in the pathophysiology of common complications encountered by lung recipients. The loss of bronchial circulation into the allograft after transplant surgery results in ischemia-related changes in the bronchial artery territory of the allograft. We discuss the role of bronchopulmonary anastomosis in blood circulation in the allograft posttransplant. We review commonly encountered complications related to loss of bronchial circulation such as allograft airway ischemia, necrosis, anastomotic dehiscence, mucociliary dysfunction, and bronchial stenosis. Loss of dual circulation to the lung also increases the risk of pulmonary infarction with acute pulmonary embolism. The loss of lymphatic drainage during transplant surgery also impairs the management of allograft interstitial fluid, resulting in pulmonary edema and early pleural effusion. We discuss the role of lymphatic drainage in primary graft dysfunction. Besides, we review the association of late posttransplant pleural effusion with complications such as acute rejection. We then review the impact of loss of afferent and efferent innervation from the allograft on control of breathing, as well as lung protective reflexes. We conclude with discussion about pulmonary function testing, allograft monitoring with spirometry, and classification of chronic lung allograft dysfunction phenotypes based on total lung capacity measurements. We also review factors limiting physical exercise capacity after lung transplantation, especially impairment of muscle metabolism. © 2023 American Physiological Society. Compr Physiol 13:4269-4293, 2023.
肺移植对肺生理的影响。
肺移植是终末期肺病患者的一种治疗选择;然而,与其他实体器官相比,生存结果仍然较差。我们回顾了肺移植手术引起的一些解剖和生理变化,以及它们在肺受体常见并发症的病理生理中的作用。同种异体移植物移植手术后支气管循环的丧失导致同种异体移植物支气管动脉区域缺血相关的改变。我们讨论了支气管肺吻合术在同种异体移植术后血液循环中的作用。我们回顾了常见的与支气管循环丧失相关的并发症,如同种异体移植气道缺血、坏死、吻合口破裂、纤毛粘膜功能障碍和支气管狭窄。肺双循环的丧失也会增加急性肺栓塞并发肺梗死的风险。移植手术中淋巴引流的丧失也损害了同种异体移植物间质液的处理,导致肺水肿和早期胸腔积液。我们讨论淋巴引流在原发性移植物功能障碍中的作用。此外,我们回顾了移植后晚期胸腔积液与急性排斥反应等并发症的关系。然后我们回顾了同种异体移植物传入和传出神经支配的丧失对呼吸控制以及肺保护性反射的影响。最后,我们讨论了肺功能测试,用肺活量测定法监测同种异体移植物,以及基于总肺活量测量的慢性同种异体移植物功能障碍表型分类。我们也回顾了肺移植后限制运动能力的因素,特别是肌肉代谢的损害。©2023美国生理学会。中国生物医学工程学报(英文版),2009(3):469 -4293。
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