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中华移植杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 81 -86. doi: 10.3877/cma.j.issn.1674-3903.2019.02.001

所属专题: 指南与规范 专题评论 文献 指南共识

诊疗规范

中国肺移植受者选择与术前评估技术规范(2019版)
中华医学会器官移植学分会   
  • 收稿日期:2019-01-17 出版日期:2019-05-25

Techical specification for the selection of recipient and preoperative evaluation of lung transplantation in China (2019 edition)

Branch of Organ Transplantation of Chinese Medical Association   

  • Received:2019-01-17 Published:2019-05-25
引用本文:

中华医学会器官移植学分会. 中国肺移植受者选择与术前评估技术规范(2019版)[J]. 中华移植杂志(电子版), 2019, 13(02): 81-86.

Branch of Organ Transplantation of Chinese Medical Association. Techical specification for the selection of recipient and preoperative evaluation of lung transplantation in China (2019 edition)[J]. Chinese Journal of Transplantation(Electronic Edition), 2019, 13(02): 81-86.

受者筛选是肺移植成功的重要决定因素之一,严格的术前评估及充分准备是获得满意疗效的关键。为了进一步规范我国肺移植受者选择以及术前评估和准备,中华医学会器官移植学分会根据我国近20年肺移植临床实践经验,并结合国际心肺移植协会肺移植受者选择指南,从肺移植适应证和禁忌证、各种终末期肺疾病手术时间选择以及术前检查内容等方面,制订中国肺移植受者选择与术前评估技术规范(2019版)。

表1 肺移植禁忌证
绝对禁忌证
? (1)难以纠正的心脏、肝脏和肾脏等重要器官功能不全(器官联合移植除外)
? (2)恶性肿瘤晚期
? (3)无法通过CABG和PCI缓解的冠心病或合并严重的左心功能不全(但部分患者经严格筛选后可考虑心肺联合移植)
? (4)生理状态不稳定,如败血症、急性心肌梗死和急性肝衰竭等
? (5)无法纠正的出血倾向
? (6)依从性差,不能配合治疗或定期随访
? (7)未治疗的精神疾病或心理状况无法配合治疗者
? (8)缺乏可靠的社会、家庭支持
相对禁忌证
? (1)年龄>75岁(但年龄仅为一项参考条件,无绝对上限)
? (2)进行性或严重营养不良
? (3)严重骨质疏松
? (4)移植前使用机械通气和/或体外生命支持(需谨慎对待,排除其他重要器官的急、慢性功能不全后可考虑行肺移植)
? (5)存在高毒力或高度耐药的细菌、真菌定植或感染,或特定的分枝杆菌菌株定植或感染(如慢性肺部感染且预期肺移植术后难以控制)
? (6)HBV或HCV感染(排除肝硬化和门静脉高压且无明显临床症状、影像学和生化检查无异常者可行肺移植)
? (7)HIV感染(HIV-RNA检测阴性并联合抗逆转录病毒治疗者,可考虑在HIV治疗经验丰富的移植中心行肺移植)
? (8)洋葱伯克霍尔德菌、唐菖蒲伯克霍尔德菌和多重耐药的分枝杆菌感染(得到充分治疗和控制者可在感染治疗经验丰富的移植中心行肺移植)
? (9)动脉粥样硬化性疾病(可在肺移植前予相应治疗,如冠心病患者应在肺移植术前行PCI或CABG)
? (10)其他未达到终末期状态的疾病(如糖尿病、高血压、消化性溃疡或胃食管反流等,应在肺移植术前积极处理)
表2 COPD肺移植评估和移植标准
表3 ILD肺移植评估和移植标准
表4 CF/支气管扩张肺移植评估和移植标准
表5 PAH肺移植评估和移植标准
1
Maurer JR, Frost AE, Estenne M, et al. International guidelines for the selection of lungtransplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society[J]. J Heart Lung Transplant, 1998, 17(7): 703-709.
2
Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update-a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation[J]. J Heart Lung Transplant, 2006, 25(7): 745-755.
3
Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014-an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation[J]. J Heart Lung Transplant, 2015, 34(1): 1-15.
4
Yusen RD, Edwards LB, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Lung and Heart-Lung Transplant Report-2016; focus theme: primary diagnostic indications for transplant[J]. J Heart Lung Transplant, 2016, 35(10): 1170-1184.
5
Yusen RD, Christie JD, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report-2013; focus theme: age[J]. J Heart Lung Transplant, 2013, 32(10): 965-978.
6
Lahzami S, Bridevaux PO, Soccal PM, et al. Survival impact of lung transplantation for COPD[J]. Eur Respir J, 2010, 36(1): 74-80.
7
Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management[J]. Am J Respir Crit Care Med, 2011, 183(6): 788-824.
8
Ley B, Collard HR, King TE Jr. Clinical course and prediction of survival in idiopathic pulmonary fibrosis[J]. Am J Respir Crit Care Med, 2011, 183(4): 431-440.
9
Taylor DA, du Bois RM. Idiopathic interstitial pneumonias: a re-appraisal of idiopathic pulmonary fibrosis[J]. Int J Tuberc Lung Dis, 2001, 5(12): 1086-1098.
10
Michaelson JE, Aguayo SM, Roman J. Idiopathic pulmonary fibrosis: a practical approach for diagnosis and management[J]. Chest, 2000, 118(3): 788-794.
11
Selman M, King TE, Pardo A; American Thoracic Society; European Respiratory Society; American College of Chest Physicians. Idiopathic pulmonary fibrosis: prevaling and evolving hypotheses about its pathogenesis and implications for therapy[J]. Ann Intern Med, 2001, 134(2): 136-151.
12
Noble PW. Idiopathic pulmonary fibrosis: natural history and prognosis[J]. Clin Chest Med, 2006, 27(1 Suppl 1): S11-S16.
13
Christie JD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult lung and heart-lung transplant report-2010[J]. J Heart Lung Transplant, 2010, 29(10): 1104-1118.
14
Takagishi T, Ostrowsik R, Alex C, et al. Survival and extrapulmonary course of connective tissue disease after lung transplantation[J]. J Clin Rheumatol, 2012, 18(6): 283-289.
15
Showkat A, Lo A, Shokouh-Amiri H, et al. Are autoimmune disease of glomerulonephritis affecting the development of panel-reactive antibodies in candidates for renal transplantation?[J]. Transplant Proc, 2005, 37(2): 645-647.
16
Banham G, Prezzi D, Harford S, et al. Elevated pretansplantation soluble BAFF is associated with an increased risk of acute antibody mediated rejection[J]. Transplantation, 2013, 96(4): 413-420.
17
Doyle TJ, Dellaripa PF. Lungmanifestations of the rheumatic disease[J]. Chest, 2017, 152(6): 1283-1295.
18
Khan IY, Singer LG, de Perrot M, et al. Survival after lung transplantation in systemic sclerosis. A systematic review[J]. Respir Med, 2013, 107(12): 2081-2087.
19
Yazdani A, Sing LG, Strand V, et al. Survival and quality of life in rheumatoid arthritis-associated interstitial lung disease after lung transplantation[J]. J Heart Lung Transplant, 2014, 33(5): 514-520.
20
Anderson LA, Gadalla S, Morton LM, et al. Population-based study of autoimmune conditions and the risk of specific lymphoid malignancies[J]. Int J Cancer, 2009, 125(2): 398-405.
21
Distler O, Pignone A. Pulmonary arterial hypertension and rheumatic disease-from diagnosis to treatment[J]. Rheumatology (Oxford), 2006, 45(Suppl 4): iv22-iv25.
22
Zhang R, Dai LZ, Xie WP, et al. Survival of Chinese patients with pulmonary arterial hypertension in the modern treatment era[J]. Chest, 2011, 140(2): 302-309.
23
Mathai SC, Hassoun PM. Pulmonary arterial hypertension associated with systemic sclerosis[J]. Expert Rev Respir Med, 2011, 5(2): 267-279.
24
Gottlieb J, Smits J, Schramm R, et al. Lung transplantation in Germany since the introduction of the lung allocation score[J]. Dtsch Arztebl Int, 2017, 114(11): 179-185.
25
Egan TM, Edwards LB. Effect of the lung allocation score on lung transplantation in the United States[J]. J Heart Lung Transplant, 2016, 35(4): 433-439.
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