1、WXPHLung Transplant HistoryFirst experimental operation:1950-54 Metras,HardinFirst human operation:1963 Hardy Recipient:58-yr-old man,emphysema Donor:MI,shock-ER left single lung TxBackground：Lung TransplantationWXPHBackground：Lung TransplantationWXPH1st Success1983-Toronto Lung Transplant Group58 y
2、r old male,IPFSurvived 7 yearsDied of kidney failure caused by anti-rejection medicationBackground：Lung TransplantationWXPHEn Bloc Double LungDark(1986)experimental technique(canine)1986 Patterson et al.-first successful en bloc double lung transplant(Alive today)Donor airway ischemia still a proble
3、mBackground：Lung TransplantationWXPHSequential Double Lung Pasque et al.Wash U.Bilateral sequential lung transplantation emerged in 1989 May avoid CPB.No need for cardioplegiaReduced bronchial anastomotic problemsBackground：Lung TransplantationWXPHLiving-donor lobar lung transplantation was introduc
4、ed by Starnes and colleagues in 1991Recipient(son)PPH Donor (mother)right lower lobe Background：Lung TransplantationWXPHThe Registry of the International Society for Heart andLung Transplantation:Twenty-seventh official adult lungand heart-lung transplant reportISHLT2010Background：Lung Transplantati
5、onWXPHNUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPEISHLTNOTE: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 performed worldwide.2010WXPHA
6、DULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants:January 1994-June 2008)ISHLT 2010WXPHADULT LUNG TRANSPLANTATION:Indications(1/1995-6/2009)ISHLT 2010WXPHADULT LUNG TRANSPLANTATIONProcedure Type within Indication,by Year ISHLT2010WXPHADULT LUNG TRANSPLANTATIONKaplan-Meier survival by diagn
7、osis(Transplants:January 1988 June 2008)ISHLT 2010WXPHADULT LUNG TRANSPLANT RECIPIENTS:Cause Of Death(Deaths:January 1992-June 2009)ISHLT 2010WXPHDonor LungFlushing to removeblood,preservationQuestions:Tm,Time,solutioninflation?TransplantationQuestion:How to do the operationReperfusionQuestions:Rate
8、,pressure,ventilation,etcTransport from A to BWXPHBARRIERS TO SUCCESSshortage of donors waiting list mortalityPGDacute rejection BOS.WXPHWXPHNovaLungBridge to Lung TransplantationWXPHWXPHNovaLungWXPHWXPHDECEASED DONORSCurrent largest,best source of donor lungsWe have NOT maximized utilizationNeed to
9、 improve utilization:Manage donors better Develop better strategies to predict post transplant lung function Strategies to assess lungs(ex-vivo)Strategies to“repair”donor lungsWXPHDonor LungPhysiologic AssessmentExcellentBiologic AssessmentExcellentTRANSPLANTFailsEx-vivo Assessment and TreatmentWXPH
10、DONOR LUNGPhysiologic AssessmentExcellentBiologic AssessmentExcellentTRANSPLANTFailsEx-vivo Assessment and TreatmentFailsGene Therapy,Other Repair StrategiesReassessFailsNo TransplantWXPHLung Transplantation in China First stage 1978 Dr.Xing Yu-ling,first SLTx for TB in China,died 1995 Dr.Chen Yu-pi
11、ng SLTx for IPF survived 1998 Dr.Chen Yu-ping BLTx for PPH with CPB urvived WXPH1978 Dr.Xing Yu-ling first SLTx for TB in China,WXPHDr.Chen Yu-ping 1995-2-23,SLTx for IPF survived 5y10m 1998-1-20,BLTx for PPH with CPB,survived 4y3mBackground：Lung TransplantationWXPHFrom 1994 to 1998,about 20 cases w
12、ere performed,only 2 patients survived.The LTx stoped in China from 1998-Sep.2002 because of low survival rate.WXPHSecond stage Since the SLTx for COPD was performed by Wuxi Group on Sep.2002,remarkable progress have be achieved in China.WXPH移植器官种类首例（年）至07年累计例数至今累计例数尸体肾移植196980488105000（预计）活体肾移植1973
13、14952500（预计）尸体肝移植19771273020251活体肝移植19951391569心脏移植19785341100（预计）肺移植1979128260（预计）小肠移植19941540（预计）器官移植学会登记处各种器官移植统计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据中心WXPHWXPHWXPHNumber of lung transplants in China(1978-2010)WXPHWXPHWXPH本中心本中心WXPHResult1，2，3,5 year survive rate is 73.3%,61.6%,53.5%,40.7%.WXPHInsision
14、considerationBilateral anterolateral thoracotomiesClamshell incision(trans-sternal Bilateral thoracotomy incision)Antero muscle sparing thoractomyMinimally invasive technique with VATSWXPHInsision considerationWXPHInsision considerationWXPHInsision considerationWXPHOperative technique Bronchial anas
15、tomosisArterial anastomosisLeft atrium anastomosis Size discrepancies Unusual circumstance WXPHOperative techniqueWXPHWXPHOperative techniqueWXPHPulmonary Artery AnastomosisOperative techniqueWXPHWXPHLeft Atrial AnastomosisWXPHWXPH术后病理 术后病理 BSLTxBSLTx 1st,March 2005 1st,March 20055.Ventilator depend
16、ent recipientWXPHPreoperative chest roentgenogram of a 49-year man with COPD.1.68cm,46kg,BMI 73%Preoperation depended on ventilator for 107 days.WXPHWXPHWXPHBLT without sternal divisionWXPHWXPHWXPHWXPH12.Male,46y,BAC BLTxWXPH单肺移植同期心内缺损修补治疗艾森曼单肺移植同期心内缺损修补治疗艾森曼格综合征格综合征男性，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
17、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。WXPHWXPHWXPHn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）。WXPH术后术后30天胸片及胸部天胸片及胸部CT显示右移植肺清晰，肺显示右移植肺清晰，肺通气血流灌注扫描示右通气血流灌注扫描示右侧移植肺血流占侧移
18、植肺血流占90%，UCG示左室内径较术前示左室内径较术前缩小缩小17%，室缺修补完，室缺修补完整无残余分流，术后活整无残余分流，术后活动耐力明显改善，动耐力明显改善，62天天出院。出院。术后随访已有术后随访已有5近年，生近年，生活质量良好。活质量良好。WXPH16 F，PPH,BLT WITH ECMOWXPHWXPHWXPH术前术前术后术后左室舒张末内径左室舒张末内径*23 mm47 mm右室舒张末内径右室舒张末内径*54.7 mm28 mm左房内径左房内径*21 mm34 mm主动脉根部内径主动脉根部内径*24 mm25 mm主肺动脉内径主肺动脉内径44.5 mm22 mm左肺动脉内径左肺
19、动脉内径30.9 mm14 mm右肺动脉内径右肺动脉内径26.2 mm14 mm肺动脉收缩压肺动脉收缩压159.4 mmHg三尖瓣和肺动脉瓣无返流三尖瓣和肺动脉瓣无返流平均肺动脉压平均肺动脉压92.4 mmHg三尖瓣和肺动脉瓣无返流三尖瓣和肺动脉瓣无返流左室射血分数左室射血分数82%69%右室射血分数右室射血分数19%62%每搏输出量每搏输出量19.7 ml63 ml移植前后心超结果比较（术前及术后移植前后心超结果比较（术前及术后2.5月）月）WXPHhttp:/ 病毒及乙肝均为阴性。三位供体均同时捐献心、肺、肝、肾和角膜等多个器官。供体二男性27岁脑外伤12天310供体三男性31岁脑外伤6天
20、420供 体 资 料WXPH资料与方法资料与方法供 体 资 料WXPH供体肺手术方法供体肺手术方法资料与方法资料与方法WXPH供体肺手术方法供体肺手术方法资料与方法资料与方法WXPH性别年龄性别年龄诊断诊断其他其他受体一男性32岁支扩伴感染、肺心病、呼衰感染已控制，无发热、咯血，需间断吸氧受体二男性34岁矽肺终末期、肺动脉高压右心功能不全、呼衰长期咳嗽、气喘，术前已卧床吸氧治疗受体三男性61岁IPF、肺动脉高压右心功能不全、呼衰活动后气喘明显，需卧床吸氧受 体 资 料WXPHTransplant for late stage of PneumosilicosisWXPHWXPHWXPHWXPH主办国家级继续教育项目主办国家级继续教育项目5项项(2004-2010年年)全国第一至第五届心肺移植会议全国第一至第五届心肺移植会议WXPHWXPHWXPHWuxi Lung Transplant CenterWebsite：www.中国心肺移植中国心肺移植.cn Email:Tel:13003329213http:/ 陈静瑜肺腑之言陈静瑜肺腑之言
