ObjectiveTo explore the method for establishing a pig left lung orthotopic transplantation model. MethodsDetailed surgical procedures, including animal anesthesia, tracheal intubation, donor lung retrieval, and recipient transplantation, were thoroughly reported. By examining the histological morphology and blood gas analysis of the transplanted lung 2 hours after reperfusion, the histological changes and function of the transplanted lung were assessed. ResultsThis method was applied to four male Yorkshire pigs with an average weight of (40.0 ±2.5) kg for left lung in situ transplantation, effectively simulating conditions relevant to human lung transplantation. Two hours after the transplantation, arterial blood gas analysis showed PaO2 was 155.4-178.6 mm Hg, PaCO2 was 53.1-62.4 mm Hg, and the oxygenation index was 310.8-357.2 mm Hg. Hematoxylin and eosin staining indicated a low degree of pulmonary edema and minimal cellular infiltration. ConclusionThe pig left lung orthotopic transplantation model possesses strong operability and stability. Researchers can replicate this model according to the described methods and further conduct basic research and explore clinical translational applications.
ObjectiveTo evaluate the clinical efficacy of balloon bronchoplasty and metallic stents in lung transplant-related central airway stenosis.MethodsData of lung transplant recipients with central airway stenosis who underwent therapeutic bronchoscopic interventions between January 2011 and June 2019 at our institution were reviewed. The clinical follow-up included dyspnea index, forced expiratory Forced expiratory volume in one second (FEV1), six-minute walk distance (6MWD), and the rate of bronchoscopic dilation.ResultsThirty-four lung transplant recipients with airway stenosis were included in our study. All these patients were treated by balloon bronchoplasty through flexural bronchoscopy, and 7 additionally needed temporary metal stent implantation for 28 to 67 days in order to palliate recurrent central airway stenosis. The percentages of immediate efficacy were 86% (180/209) and 100% (7/7), respectively. After serial balloon dilatation, the recipients with central airway stenosis had significantly lower dyspnea index (3.24±0.55 vs. 1.91±0.62, P<0.01), higher FEV1 ［(1.43±0.21)L vs. (1.72±0.27)L, P<0.01］ and longer 6MWD ［(317.3±61.7)m vs. (372.9±52.6)m, P<0.01］. Six recipients with central airway stenosis received 33 interventions in 6 months before stent implantation and 10 interventions in 6 months after stent extraction.ConclusionsLung transplant recipients with central airway stenosis have a good respond to balloon bronchoplasty and stent placement. Airway stenosis after lung transplantation can be successfully managed with bronchoscopic dilatation and temporary stent placement.
Objective To summarize the clinical experience of harvesting the lung of a brain death donor by international standardized methods, so as to establ ish a set of standards and regulations appl icable for harvesting the lung of brain-death donors in China. Methods The operation was performed on 1 brain-death donor who had endured 50 hours of mechanical ventilation. The donor was assessed by donor lung function test and international brain death standard. Then the organ was perfused and trimmed ready for lung transplantation. Results We succeeded in harvesting the heart, lung, liver, kidney and cornea from this brain-death voluntary donor. The harvested lung was successfully transplanted into a recipient. And the recipient recovered well after operation. Conclusion The successful experience of harvesting the lung of the brain-death voluntary donor will contribute to the development and promotion of the utilization of brain-death donor suppl ies.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
The rehabilitation experience of 20 patients with tracheostomy after lung transplantation was reported, and the key points of rehabilitation nursing included sequential oxygen therapy, airway clearance, diaphragm pacing, respiratory training, swallowing training, speech training, exercise training, and gastrointestinal function rehabilitation. Tracheostomy is conducive to airway management and offline extubation in patients assisted by long-term breathing, and promotes patient recovery and discharge through multidisciplinary collaborative rehabilitation nursing integrated case management.
Lung transplantation has been the only valid method in treating end-stage lung diseases, airway complications are the main cause to the failure of surgery and common postoperative complications. With the development on patient selection, organ preservation, surgical technique, immunosuppressive therapy and postoperative surveillance, the successful ratio of surgery has become most satisfactory. However, airway complications are still common after lung transplantation. Among these, the airway anastomosis stenosis is more predominant than others. The living quality and long-dated survival rate are highly improved by paying enough attention to the formation,corresponding management for tracheal stenosis. The progress of the cause, prevention and treatment of airway anastomosis stenosis after lung transplantation is reviewed in this article.