再次肺移植手术技术及围手术期诊疗策略的探讨—附1例病例分析
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摘要
背景肺移植是目前治疗终末期肺病的主要方法之一,我国于1979年首先开展临床肺移植手术,1996年我国首例临床单肺移植手术成功。2003年开始才逐步在全国少数几家医院成功,而且失败率仍然很高。再次肺移植是移植肺衰竭后唯一有效的治疗手段,但目前对其临床价值还有很多争议,我们通过1例再次肺移植患者的病例分析,对再次肺移植手术技术及围手术期诊疗策略进行初步探讨。
目的再次肺移植是移植肺衰竭后唯一有效的治疗手段。探讨再次肺移植手术技术及肺移植围手术期的诊疗策略。
方法浙江大学医学院附属第一医院于2011年8月首次完成1例再次肺移植手术,患者系单肺移植后5年因闭塞性细支气管炎导致移植物失功。手术方式为对侧单肺移植,选择体外膜肺术中辅助,术后予以控制肺水肿、免疫抑制、抗感染等治疗。
结果本例患者顺利接受手术,手术时间为：143min,冷缺血时间为：140min,术中出血为2850m1。术后予以血流动力学监测及呼吸管理,患者术后24小时内拔除气管插管,术后第2周转普通病房,并于术后第5周出院,术后至今随访18个月,目前各项指标均满意。
结论再次肺移植是治疗移植肺功能衰竭的有效手段,严格把握手术适应证,合理选择受者,良好的手术操作技术及合理的围手术期诊疗管理是肺移植手术成功的关键。
Background
Lung transplantation is on of the most important treatments for end-stage respiratory failure. Although lung retransplantation is the only definitive theraputic option in lung recipients with bronchiolitis obliterans syndrome after lung transplantation, its value remains a considerable source of controversy. Here we share our experience of surgical techniques and perioperative managements of lung retransplantation performed in our center.
Objective
To discuss the surgical techniques and perioperative treatment strategies of lung retransplantation
Method
We performed the fisrt case of lung retransplantation to treat a patient of graft dysfunction with bronchiolitis obliterans syndrome in the First Affiliated Hospital of College of Medicine of Zhejiang University on August2011. The surgical approache was contralateral single-lung transplantation, aided by extracorporeal membrane oxygenation.
Results
The patient was successfully received surgery, and the operative time was143min.The cold ischemia time was140min. The blood loss volume during the operation was2850ml. After operation the patient was treated with control of pulmonary edema, immunosuppressive, anti-infection therapy. The patient was extubated within24hours, and then transferred to general ward in2weeks, and discharge in five weeks. Until now all the perioperative indicators of the patients are satisfied.
Conclusion
With strictly controlled indications, properly selected lung recipents,advanced surgical techniques and perioperative managements, lung retransplantation is a safe and effective therapeutic option in lung recipents with bronchiolitis obliterans syndrome after lung transplantation.
目的再次肺移植是移植肺衰竭后唯一有效的治疗手段。探讨再次肺移植手术技术及肺移植围手术期的诊疗策略。
方法浙江大学医学院附属第一医院于2011年8月首次完成1例再次肺移植手术,患者系单肺移植后5年因闭塞性细支气管炎导致移植物失功。手术方式为对侧单肺移植,选择体外膜肺术中辅助,术后予以控制肺水肿、免疫抑制、抗感染等治疗。
结果本例患者顺利接受手术,手术时间为：143min,冷缺血时间为：140min,术中出血为2850m1。术后予以血流动力学监测及呼吸管理,患者术后24小时内拔除气管插管,术后第2周转普通病房,并于术后第5周出院,术后至今随访18个月,目前各项指标均满意。
结论再次肺移植是治疗移植肺功能衰竭的有效手段,严格把握手术适应证,合理选择受者,良好的手术操作技术及合理的围手术期诊疗管理是肺移植手术成功的关键。
Background
Lung transplantation is on of the most important treatments for end-stage respiratory failure. Although lung retransplantation is the only definitive theraputic option in lung recipients with bronchiolitis obliterans syndrome after lung transplantation, its value remains a considerable source of controversy. Here we share our experience of surgical techniques and perioperative managements of lung retransplantation performed in our center.
Objective
To discuss the surgical techniques and perioperative treatment strategies of lung retransplantation
Method
We performed the fisrt case of lung retransplantation to treat a patient of graft dysfunction with bronchiolitis obliterans syndrome in the First Affiliated Hospital of College of Medicine of Zhejiang University on August2011. The surgical approache was contralateral single-lung transplantation, aided by extracorporeal membrane oxygenation.
Results
The patient was successfully received surgery, and the operative time was143min.The cold ischemia time was140min. The blood loss volume during the operation was2850ml. After operation the patient was treated with control of pulmonary edema, immunosuppressive, anti-infection therapy. The patient was extubated within24hours, and then transferred to general ward in2weeks, and discharge in five weeks. Until now all the perioperative indicators of the patients are satisfied.
Conclusion
With strictly controlled indications, properly selected lung recipents,advanced surgical techniques and perioperative managements, lung retransplantation is a safe and effective therapeutic option in lung recipents with bronchiolitis obliterans syndrome after lung transplantation.
引文
[1]DARK J H, PATTERSON G A, AL-JILAIHAWI A N, et al. Experimental En Bloc Double-Lung Transplantation [J]. The Annals of thoracic surgery,1986,42(4): 394-8.
[2]PATTERSON G A, COOPER J D, GOLDMAN B, et al. Technique of Successful Clinical Double-Lung Transplantation [J]. The Annals of thoracic surgery,1988, 45(6):626-33.
[3]STEEN S, SJ BERG T, PIERRE L, et al. Transplantation of lungs from a non-heart-beating donor [J]. The Lancet,2001,357(9259):825-9.
[4]辛育龄,蔡廉甫,胡启邦.人体肺移植一例报告[J].中华外科杂志,1979,17(3)：28.
[5]陈玉平,张志泰.肺移植治疗肺纤维化一例报告[J].中华外科杂志,1996,34(1)：25-8.
[6]高文,王兴安.国内肺移植评述(1979-2009年)[J].同济大学学报：医学版,2009,30(004)：5-11.
[7]CHRISTIE J D, EDWARDS L B, KUCHERYAVAYA A Y, et al. The Registry of the International Society for Heart and Lung Transplantation:29th Adult Lung and Heart-Lung Transplant Report-2012 [J]. The Journal of Heart and Lung Transplantation,2012,31(10):1073-86.
[8]CHAPARRO C, MAURER J, GUTIERREZ C, et al. Infection with Burkholderia cepacia in Cystic Fibrosis:Outcome Following Lung Transplantation [J]. American Journal of Respiratory and Critical Care Medicine,2001,163(1):43-8.
[9]KOTLOFF R M, THABUT G. Lung Transplantation [J]. American Journal of Respiratory and Critical Care Medicine,2011,184(2):159-71.
[10]陈实.肺移植[M].北京；人民卫生出版社.2011：426页.
[11]GAFFNEY A M, WILDHIRT S M, GRIFFIN M J, et al. Extracorporeal life support [J]. BMJ,2010,341 (
[12]GOPAL M, ORSI D, KHILKIN M, et al. Use of Extracorporeal Membrane Oxygenation (ECMO) as a Salvage Therapy for Refractory Hypoxemia Secondary to Acute Chest Syndrome [J]. CHEST Journal,2011,140(4_MeetingAbstracts): 150A-A.
[13]MORRIS A. Exciting new ECMO technology awaits compelling scientific evidence for widespread use in adults with respiratory failure [J]. Intensive Care Med,2012,38(2):186-8.
[14]FINNEY S J, CORDINGLEY J J, GRIFFITHS M J D, et al. ECMO in adults for severe respiratory failure finally comes of age:just in time? [J]. Thorax,2010, 65(3):194-5.
[15]SHIN T G, CHOI J-H, JO I J, et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest:A comparison with conventional cardiopulmonary resuscitation* [J]. Critical care medicine,2011,39(1):1.
[16]KJ RGAARD B, RASMUSSEN B S, DE NEERGAARD S, et al. Extracorporeal cardiopulmonary support may be an efficient rescue of patients after massive pulmonary embolism. An experimental porcine study [J]. Thrombosis Research, 2012.
[17]ZWISCHENBERGER J B, ALPARD S K. Artificial lungs:a new inspiration [J]. Perfusion,2002,17(4):253-68.
[18]BERMUDEZ C A, ADUSUMILLI P S, MCCURRY K R, et al. Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: long-term survival [J]. Annals of Thoracic Surgery,2009,87(3):854.
[19]IACONO A, GROVES S, GARCIA J, et al. Lung transplantation following 107 days of extracorporeal membrane oxygenation [J]. European Journal of Cardio-Thoracic Surgery,2010,37(4):969-71.
[20]胡春晓,胡毅平,张建余,et al.体外膜肺氧合在肺移植麻醉中.的应用[J].国际麻醉学与复苏杂志,2009,30(2)：103-5.
[21]陈静瑜,郑明峰,朱艳红,et a1.肺移植治疗特发性肺间质纤维化32例报告[J].中华器官移植杂志,2010,4)：213-5.
[22]MARTINEZ F J, SAFRIN S, WEYCKER D, et al. The clinical course of patients with idiopathic pulmonary fibrosis [J]. Annals of Internal Medicine,2005, 142(12_Part_1):963-7.
[23]GROSS T J, HUNNINGHAKE G W. Idiopathic pulmonary fibrosis [J]. New England Journal of Medicine,2001,345(7):517-25.
[24]GLANVILLE A R, ESTENNE M. Indications, patient selection and timing of referral for lung transplantation [J]. European Respiratory Journal,2003,22(5): 845-52.
[25]陈静瑜,郑明峰,朱艳红,et al.肺移植治疗肺纤维化10例临床分析[J].中华结核和呼吸杂志,2006,29(10)：694-7.
[26]MASON D P, BRIZZIO M E, ALSTER J M, et al. Lung transplantation for idiopathic pulmonary fibrosis [J]. The Annals of thoracic surgery,2007,84(4): 1121-8.
[27]MEYERS B F, LYNCH J P, TRULOCK E P, et al. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis [J]. The Journal of thoracic and cardiovascular surgery,2000,120(1):99-107.
[28]THABUT G, CHRISTIE J D, RAVAUD P, et al. Survival after bilateral versus single-lung transplantation for idiopathic pulmonary fibrosis [J]. Annals of Internal Medicine,2009,151(11):767-74.
[29]SHORR A F, WAINRIGHT J L, CORS C S, et al. Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplant [J]. European Respiratory Journal,2007,30(4):715-21.
[30]DE PERROT M, CHAPARRO C, MCRAE K, et al. Twenty-year experience of lung transplantation at a single center:influence of recipient diagnosis on long-term survival [J]. The Journal of thoracic and cardiovascular surgery,2004, 127(5):1493-501.
[31]WARNECKE G, HAVERICH A. Lung re-transplantation:review [J]. Current Opinion in Organ Transplantation,2012,17(5):485-9 10.1097/MOT.0b013e328357d8ba.
[32]KAWUT S M, LEDERER D J, KESHAVJEE S, et al. Outcomes after Lung Retransplantation in the Modern Era [J]. American Journal of Respiratory and Critical Care Medicine,2008,177(1):114-20.
[33]SIDDIQUE A, KNOPER S, RAZ Y, et al.618 Recurrence of Bronchiolitis Obliterans May Limit Long-Term Outcomes in Lung Retransplantation [J]. The Journal of Heart and Lung Transplantation,2011,30(4):S206-S7.
[34]BUDEV M M. Lung retransplantation:a new era for lung transplantation [J]. Current Opinion in Organ Transplantation,2007,12(5):464-8 10.1097/MOT.0b013e3282f00503.
[35]STRUEBER M, FISCHER S, GOTTLIEB J, et al. Long-term outcome after pulmonary retransplantation [J]. The Journal of thoracic and cardiovascular surgery,2006,132(2):407-12.
[36]BRUGIERE O, THABUT G, CASTIER Y, et al. Lung Retransplantation for Bronchiolitis Obliterans Syndrome*Long-term Follow-up in a Series of 15 Recipients [J]. CHEST Journal,2003,123(6):1832-7.
[37]AIGNER C, JAKSCH P, TAGHAVI S, et al. Pulmonary Retransplantation:Is it Worth the Effort? A Long-term Analysis of 46 Cases [J]. The Journal of Heart and Lung Transplantation,2008,27(1):60-5.
[38]NOVICK MD R J, STITT MSC L W, AL-KATTAN MD K, et al. Pulmonary Retransplantation:Predictors of Graft Function and Survival in 230 Patients [J]. The Annals of thoracic surgery,1998,65(1):227-34.
[39]WEKERLE T, KLEPETKO W, WISSER W, et al. Lung retransplantation: institutional report on a series of twenty patients [J]. The Journal of heart and lung transplantation:the official publication of the International Society for Heart Transplantation,1996,15(2):182-9.
[40]STR BER M, HOHLFELD J M, KOFIDIS T, et al. Surfactant function in lung transplantation after 24 hours of ischemia:advantage of retrograde flush perfusion for preservation [J]. The Journal of thoracic and cardiovascular surgery,2002, 123(1):98-103.
[41]WITTWER T, FEHRENBACH A, MEYER D, et al. Retrograde flush perfusion with low-potassium solutions for improvement of experimental pulmonary preservation [J]. The Journal of Heart and Lung Transplantation,2000,19(10): 976-83.
[42]WITTWER T, FRANKE U, FEHRENBACH A, et al. Impact of retrograde graft preservation in Perfadex-based experimental lung transplantation [J]. Journal of Surgical Research,2004,117(2):239-48.
[43]胡春晓,郑明峰,王雁娟,et al.体外膜肺氧合在临床肺移植中的应用[J].中华器官移植杂志,2011,32(10)：611-3.
[44]MURTHY S C, GILDEA T R, MACHUZAK M S. Anastomotic airway complications after lung transplantation [J]. Current Opinion in Organ Transplantation,2010,15(5):582-7.
[45]INCI I, WEDER W. Airway complications after lung transplantation can be avoided without bronchial artery revascularization [J]. Current Opinion in Organ Transplantation,2010,15(5):578-81.
[46]LAU C L, PATTERSON G A, PALMER S M. Critical care aspects of lung transplantation [J]. Journal of Intensive Care Medicine,2004,19(2):83-104.
[47]CHATILA W M, FURUKAWA S, GAUGHAN J P, et al. Respiratory failure after lung transplantation [J]. CHEST Journal,2003,123(1):165-73.
[48]胡春晓,朱艳红,陈静瑜,et al.机械通气在肺移植术后的临床应用[J].中国危重病急救医学,2004,24(6)：468-9.
[49]SAJJAN U, COREY M, HUMAR A, et al. Immunolocalisation of Burkholderia cepacia in the lungs of cystic fibrosis patients [J]. Journal of Medical Microbiology, 2001,50(6):535-46.
[50]IVERSEN M, BURTON C, VAND S, et al. Aspergillus infection in lung transplant patients:incidence and prognosis [J]. European Journal of Clinical Microbiology & Infectious Diseases,2007,26(12):879-86.
[51]AVERY R K. Antifungal prophylaxis in lung transplantation; proceedings of the Seminars in respiratory and critical care medicine, F,2011 [C].(?) Thieme Medical Publishers.
[52]KOTLOFF R, AHYA V. Medical complications of lung transplantation [J]. European Respiratory Journal,2004,23(2):334-42.
[53]MEHRAD B, PACIOCCO G, MARTINEZ F J, et al. Spectrum of Aspergillus infection in lung transplant recipientsCase series and review of the literature [J]. CHEST Journal,2001,119(1):169-75.
[54]NIEDERMAN M S, CRAVEN D, BONTEN M, et al. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia [J]. Am J Respir Crit Care Med,2005,171(4): 388-416.
[55]LEVINE S M. A survey of clinical practice of lung transplantation in North America [J]. CHEST Journal,2004,125(4):1224-38.
[56]KRUGER R M, PARANJOTHI S, STORCH G A, et al. Impact of prophylaxis with cytogam alone on the incidence of CMV viremia in CMV-seropositive lung transplant recipients [J]. The Journal of Heart and Lung Transplantation,2003, 22(7):754-63.
[57]DUMMER J S, LAZARIASHVILLI N, BARNES J, et al. A survey of anti-fungal management in lung transplantation [J]. The Journal of Heart and Lung Transplantation,2004,23(12):1376-81.
[58]KNOOP C, HAVERICH A, FISCHER S. Immunosuppressive therapy after human lung transplantation [J]. European Respiratory Journal,2004,23(1):159-71.
[59]PALMER S M, MIRALLES A P, LAWRENCE C M, et al. Rabbit antithymocyte globulin decreases acute rejection after lung transplantationresults of a randomized, prospective study [J]. CHEST Journal,1999,116(1):127-33.
[60]KRASINSKAS A M, KREISEL D, ACKER M A, et al. CD3 monitoring of antithymocyte globulin therapy in thoracic organ transplantation [J]. Transplantation,2002,73(8):1339-41.
[61]BROCK M V, BORJA M C, FERBER L, et al. Induction therapy in lung transplantation:a prospective, controlled clinical trial comparing OKT3, anti-thymocyte globulin, and daclizumab [J]. The Journal of heart and lung transplantation:the official publication of the International Society for Heart Transplantation,2001,20(12):1282-90.
[62]MEIER-KRIESCHE H U, LI S, GRUESSNER R W G,et al. Immunosuppression: Evolution in Practice and Trends,1994-2004 [J]. American Journal of Transplantation,2006,6(5p2):1111-31.
[63]HELDERMAN J H, BENNETT W M, CIBRIK D M, et al. Immunosuppression: practice and trends [J]. American Journal of Transplantation,2003,3(s4):41-52.
[64]KRISHNAM M S, SUH R D, TOMASIAN A, et al. Postoperative Complications of Lung Transplantation:Radiologic Findings along a Time Continuum1 [J]. Radiographics,2007,27(4):957-74.
[1]Fire, A., S. Xu, et al. (1998). "Potent and specific genetic interference by double-stranded RNA in Caenorhabditis elegans." Nature 391(6669):806-811.
[2]He, L. and G. J. Hannon (2004). "MicroRNAs:small RNAs with a big role in gene regulation." Nat Rev Genet 5(7):522-531.
[3]Bernstein, E., S. Y. Kim, et al. (2003). "Dicer is essential for mouse development." Nat Genet 35(3):215-217.
[4]Williams, A. (2008). "Functional aspects of animal microRNAs." Cellular and Molecular Life Sciences 65(4):545-562.
[5]Stefani, G. and F. J. Slack (2008). "Small non-coding RNAs in animal development." Nat Rev Mol Cell Biol 9(3):219-230.
[6]Sonkoly, E., T. Wei, et al. (2007). "MicroRNAs:novel regulators involved in the pathogenesis of psoriasis?" PLoS ONE 2(7).
[7]Jopling, C. L., M. Yi, et al. (2005). "Modulation of Hepatitis C Virus RNA Abundance by a Liver-Specific MicroRNA." Science 309(5740):1577-1581.
[8]Chen, C.-Z. and H. F. Lodish (2005). "MicroRNAs as regulators of mammalian hematopoiesis." Seminars in Immunology 17(2):155-165.
[9]S. Ikeda, S.W. Kong, J. Lu, E. Bisping, H. Zhang and P.D. Allen et al., Altered microRNA expression in human heart disease, Physiol Genomics 31 (2007), pp. 367-373.
[10]J. Lu, G. Getz, E.A. Miska, E. Alvarez-Saavedra, J. Lamb and D. Peck et al., MicroRNA expression profiles classify human cancers, Nature 435 (2005), pp. 834-838
[11]A. Care, D. Catalucci, F. Felicetti, D. Bonci, A. Addario and P. Gallo et al., MicroRNA-133 controls cardiac hypertrophy, Nat Med 13 (2007), pp.613-618.
[12]Sheedy, F. J. and L. A. J. O'Neill (2008). "Adding fuel to fire:microRNAs as a new class of mediators of inflammation." Annals of the Rheumatic Diseases 67(Suppl 3):iii50-iii55.
[13]C.Z. Chen et al., MicroRNAs modulate hematopoietic lineage differentiation, Science 303 (2004), pp.83-86.
[14]Shivdasani, R. A. (2006). "MicroRNAs:Regulators of gene expression and cell differentiation." Blood 108(12):3646-3653.
[15]Neilson, J. R., G. X. Y. Zheng, et al. (2007). "Dynamic regulation of miRNA expression in ordered stages of cellular development." Genes and Development 21(5):578-589.
[16]Li, Q. J., J. Chau, et al. (2007). "miR-181a Is an Intrinsic Modulator of T Cell Sensitivity and Selection." Cell 129(1):147-161.
[17]Ebert, P. J. R., S. Jiang, et al. (2009). "An endogenous positively selecting peptide enhances mature T cell responses and becomes an autoantigen in the absence of microRNA miR-181a." Nat Immunol 10(11):1162-1169.
[18]Mustelin, T., T. Vang, et al. (2005). "Protein tyrosine phosphatases and the immune response." Nature Reviews Immunology 5(1):43-57.
[19]Fazi, F., A. Rosa, et al. (2005). "A minicircuitry comprised of microRNA-223 and transcription factors NFI-A and C/EBPa regulates human granulopoiesis." Cell 123(5):819-831.
[20]Johnnidis, J. B., M. H. Harris, et al. (2008). "Regulation of progenitor cell proliferation and granulocyte function by microRNA-223." Nature 451(7182): 1125-1129.
[21]Monticelli, S., K. M. Ansel, et al. (2005). "MicroRNA profiling of the murine hematopoietic system." Genome biology 6:R71
[22]Wu, H., J. R. Neilson, et al. (2007). "miRNA profiling of naive, effector and memory CD8 T cells." PLoS ONE 2:e1020
[23]Zhou, B., S. Wang, et al. (2007). "miR-150, a microRNA expressed in mature B and T cells, blocks early B cell development when expressed prematurely." Proceedings of the National Academy of Sciences of the United States of America 104(17):7080-7085.
[24]Xiao, C., D. P. Calado, et al. (2007). "MiR-150 Controls B Cell Differentiation by Targeting the Transcription Factor c-Myb." Cell 131(1):146-159.
[25]Xiao, C., L. Srinivasan, et al. (2008). "Lymphoproliferative disease and autoimmunity in mice with increased miR-17-92 expression in lymphocytes." Nature Immunology 9(4):405-414.
[26]Thai, T. H., D. P. Calado, et al. (2007). "Regulation of the germinal center response by MicroRNA-155." Science 316(5824):604-608.
[27]Rodriguez, A., E. Vigorito, et al. (2007). "Requirement of bic/microRNA-155 for normal immune function." Science 316(5824):608-611.
[28]Rao, D. S., R. M. O'Connell, et al. (2010). "MicroRNA-34a Perturbs B Lymphocyte Development by Repressing the Forkhead Box Transcription Factor Foxpl." Immunity 33(1):48-59.
[29]Taganov, K. D., M. P. Boldin, et al. (2006). "NF-κB-dependent induction of microRNA miR-146, an inhibitor targeted to signaling proteins of innate immune responses." Proceedings of the National Academy of Sciences of the United States of America 103(33):12481-12486.
[30]Akira, S. and K. Takeda (2004). "Toll-like receptor signalling." Nature Reviews Immunology 4(7):499-511.
[31]O'Connell, R. M., K. D. Taganov, et al. (2007). "MicroRNA-155 is induced during the macrophage inflammatory response." PNAS 104(5):1604-1609.
[32]Tili, E., J. J. Michaille, et al. (2007). "Modulation of miR-155 and miR-125b levels following lipopolysaccharide/TNF-α stimulation and their possible roles in regulating the response to endotoxin shock." Journal of Immunology 179(8): 5082-5089.
[33]Moschos, S. A., A. E. Williams, et al. (2007). "Expression profiling in vivo demonstrates rapid changes in lung microRNA levels following lipopolysaccharide-induced inflammation but not in the anti-inflammatory action of glucocorticoids." BMC Genomics 8.
[34]Perry, M. M., S. A. Moschos, et al. (2008). "Rapid Changes in MicroRNA-146a Expression Negatively Regulate the IL-1β-Induced Inflammatory Response in Human Lung Alveolar Epithelial Cells." J Immunol 180(8):5689-5698.
[35]Ceppi, M., P. M. Pereira, et al. (2009). "MicroRNA-155 modulates the interleukin-1 signaling pathway in activated human monocyte-derived dendritic cells." PNAS 106(8):2735-2740.
[36]Asangani, I. A., S. A. K. Rasheed, et al. (2007). "MicroRNA-21 (miR-21) post-transcriptionally downregulates tumor suppressor Pdcd4 and stimulates invasion, intravasation and metastasis in colorectal cancer." Oncogene 27(15): 2128-2136.
[37]Loffler, D., K. Brocke-Heidrich, et al. (2007). "Interleukin-6 dependent survival of multiple myeloma cells involves the Stat3-mediated induction of microRNA-21 through a highly conserved enhancer." Blood 110(4):1330-1333.
[38]Stittrich, A.-B., C. Haftmann, et al. (2010). "The microRNA miR-182 is induced by IL-2 and promotes clonal expansion of activated helper T lymphocytes." Nat Immunol 11(11):1057-1062.
[39]Sui, W., Y. Dai, et al. (2008). "Microarray analysis of MicroRNA expression in acute rejection after renal transplantation." Transplant Immunology 19(1):81-85.
[40]Anglicheau, D., V. K. Sharma, et al. (2009). "MicroRNA expression profiles predictive of human renal allograft status." Proceedings of the National Academy of Sciences 106(13):5330-5335.
[41]Sotolongo, B., T. Asaoka, et al. "Gene Expression Profiling of MicroRNAs in Small-Bowel Transplantation Paraffin-Embedded Mucosal Biopsy Tissue." Transplantation Proceedings 42(1):62-65.
[42]Krutzfeldt,J., N. Rajewsky, et al. (2005). "Silencing of microRNAs in vivo with /'antagomirs/'."Nature 438(7068):685-689.
[43]Brown, B. D. and L. Naldini (2009). "Exploiting and antagonizing microRNA regulation for therapeutic and experimental applications." Nat Rev Genet 10(8): 578-585.
[44]Lanford, R. E., E. S. Hildebrandt-Eriksen, et al. (2010). "Therapeutic Silencing of MicroRNA-122 in Primates with Chronic Hepatitis C Virus Infection." Science 327(5962):198-201.
[45]Kota, J., R. R. Chivukula, et al. (2009). "Therapeutic microRNA Delivery Suppresses Tumorigenesis in a Murine Liver Cancer Model." Cell 137(6): 1005-1017.
[2]PATTERSON G A, COOPER J D, GOLDMAN B, et al. Technique of Successful Clinical Double-Lung Transplantation [J]. The Annals of thoracic surgery,1988, 45(6):626-33.
[3]STEEN S, SJ BERG T, PIERRE L, et al. Transplantation of lungs from a non-heart-beating donor [J]. The Lancet,2001,357(9259):825-9.
[4]辛育龄,蔡廉甫,胡启邦.人体肺移植一例报告[J].中华外科杂志,1979,17(3)：28.
[5]陈玉平,张志泰.肺移植治疗肺纤维化一例报告[J].中华外科杂志,1996,34(1)：25-8.
[6]高文,王兴安.国内肺移植评述(1979-2009年)[J].同济大学学报：医学版,2009,30(004)：5-11.
[7]CHRISTIE J D, EDWARDS L B, KUCHERYAVAYA A Y, et al. The Registry of the International Society for Heart and Lung Transplantation:29th Adult Lung and Heart-Lung Transplant Report-2012 [J]. The Journal of Heart and Lung Transplantation,2012,31(10):1073-86.
[8]CHAPARRO C, MAURER J, GUTIERREZ C, et al. Infection with Burkholderia cepacia in Cystic Fibrosis:Outcome Following Lung Transplantation [J]. American Journal of Respiratory and Critical Care Medicine,2001,163(1):43-8.
[9]KOTLOFF R M, THABUT G. Lung Transplantation [J]. American Journal of Respiratory and Critical Care Medicine,2011,184(2):159-71.
[10]陈实.肺移植[M].北京；人民卫生出版社.2011：426页.
[11]GAFFNEY A M, WILDHIRT S M, GRIFFIN M J, et al. Extracorporeal life support [J]. BMJ,2010,341 (
[12]GOPAL M, ORSI D, KHILKIN M, et al. Use of Extracorporeal Membrane Oxygenation (ECMO) as a Salvage Therapy for Refractory Hypoxemia Secondary to Acute Chest Syndrome [J]. CHEST Journal,2011,140(4_MeetingAbstracts): 150A-A.
[13]MORRIS A. Exciting new ECMO technology awaits compelling scientific evidence for widespread use in adults with respiratory failure [J]. Intensive Care Med,2012,38(2):186-8.
[14]FINNEY S J, CORDINGLEY J J, GRIFFITHS M J D, et al. ECMO in adults for severe respiratory failure finally comes of age:just in time? [J]. Thorax,2010, 65(3):194-5.
[15]SHIN T G, CHOI J-H, JO I J, et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest:A comparison with conventional cardiopulmonary resuscitation* [J]. Critical care medicine,2011,39(1):1.
[16]KJ RGAARD B, RASMUSSEN B S, DE NEERGAARD S, et al. Extracorporeal cardiopulmonary support may be an efficient rescue of patients after massive pulmonary embolism. An experimental porcine study [J]. Thrombosis Research, 2012.
[17]ZWISCHENBERGER J B, ALPARD S K. Artificial lungs:a new inspiration [J]. Perfusion,2002,17(4):253-68.
[18]BERMUDEZ C A, ADUSUMILLI P S, MCCURRY K R, et al. Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: long-term survival [J]. Annals of Thoracic Surgery,2009,87(3):854.
[19]IACONO A, GROVES S, GARCIA J, et al. Lung transplantation following 107 days of extracorporeal membrane oxygenation [J]. European Journal of Cardio-Thoracic Surgery,2010,37(4):969-71.
[20]胡春晓,胡毅平,张建余,et al.体外膜肺氧合在肺移植麻醉中.的应用[J].国际麻醉学与复苏杂志,2009,30(2)：103-5.
[21]陈静瑜,郑明峰,朱艳红,et a1.肺移植治疗特发性肺间质纤维化32例报告[J].中华器官移植杂志,2010,4)：213-5.
[22]MARTINEZ F J, SAFRIN S, WEYCKER D, et al. The clinical course of patients with idiopathic pulmonary fibrosis [J]. Annals of Internal Medicine,2005, 142(12_Part_1):963-7.
[23]GROSS T J, HUNNINGHAKE G W. Idiopathic pulmonary fibrosis [J]. New England Journal of Medicine,2001,345(7):517-25.
[24]GLANVILLE A R, ESTENNE M. Indications, patient selection and timing of referral for lung transplantation [J]. European Respiratory Journal,2003,22(5): 845-52.
[25]陈静瑜,郑明峰,朱艳红,et al.肺移植治疗肺纤维化10例临床分析[J].中华结核和呼吸杂志,2006,29(10)：694-7.
[26]MASON D P, BRIZZIO M E, ALSTER J M, et al. Lung transplantation for idiopathic pulmonary fibrosis [J]. The Annals of thoracic surgery,2007,84(4): 1121-8.
[27]MEYERS B F, LYNCH J P, TRULOCK E P, et al. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis [J]. The Journal of thoracic and cardiovascular surgery,2000,120(1):99-107.
[28]THABUT G, CHRISTIE J D, RAVAUD P, et al. Survival after bilateral versus single-lung transplantation for idiopathic pulmonary fibrosis [J]. Annals of Internal Medicine,2009,151(11):767-74.
[29]SHORR A F, WAINRIGHT J L, CORS C S, et al. Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplant [J]. European Respiratory Journal,2007,30(4):715-21.
[30]DE PERROT M, CHAPARRO C, MCRAE K, et al. Twenty-year experience of lung transplantation at a single center:influence of recipient diagnosis on long-term survival [J]. The Journal of thoracic and cardiovascular surgery,2004, 127(5):1493-501.
[31]WARNECKE G, HAVERICH A. Lung re-transplantation:review [J]. Current Opinion in Organ Transplantation,2012,17(5):485-9 10.1097/MOT.0b013e328357d8ba.
[32]KAWUT S M, LEDERER D J, KESHAVJEE S, et al. Outcomes after Lung Retransplantation in the Modern Era [J]. American Journal of Respiratory and Critical Care Medicine,2008,177(1):114-20.
[33]SIDDIQUE A, KNOPER S, RAZ Y, et al.618 Recurrence of Bronchiolitis Obliterans May Limit Long-Term Outcomes in Lung Retransplantation [J]. The Journal of Heart and Lung Transplantation,2011,30(4):S206-S7.
[34]BUDEV M M. Lung retransplantation:a new era for lung transplantation [J]. Current Opinion in Organ Transplantation,2007,12(5):464-8 10.1097/MOT.0b013e3282f00503.
[35]STRUEBER M, FISCHER S, GOTTLIEB J, et al. Long-term outcome after pulmonary retransplantation [J]. The Journal of thoracic and cardiovascular surgery,2006,132(2):407-12.
[36]BRUGIERE O, THABUT G, CASTIER Y, et al. Lung Retransplantation for Bronchiolitis Obliterans Syndrome*Long-term Follow-up in a Series of 15 Recipients [J]. CHEST Journal,2003,123(6):1832-7.
[37]AIGNER C, JAKSCH P, TAGHAVI S, et al. Pulmonary Retransplantation:Is it Worth the Effort? A Long-term Analysis of 46 Cases [J]. The Journal of Heart and Lung Transplantation,2008,27(1):60-5.
[38]NOVICK MD R J, STITT MSC L W, AL-KATTAN MD K, et al. Pulmonary Retransplantation:Predictors of Graft Function and Survival in 230 Patients [J]. The Annals of thoracic surgery,1998,65(1):227-34.
[39]WEKERLE T, KLEPETKO W, WISSER W, et al. Lung retransplantation: institutional report on a series of twenty patients [J]. The Journal of heart and lung transplantation:the official publication of the International Society for Heart Transplantation,1996,15(2):182-9.
[40]STR BER M, HOHLFELD J M, KOFIDIS T, et al. Surfactant function in lung transplantation after 24 hours of ischemia:advantage of retrograde flush perfusion for preservation [J]. The Journal of thoracic and cardiovascular surgery,2002, 123(1):98-103.
[41]WITTWER T, FEHRENBACH A, MEYER D, et al. Retrograde flush perfusion with low-potassium solutions for improvement of experimental pulmonary preservation [J]. The Journal of Heart and Lung Transplantation,2000,19(10): 976-83.
[42]WITTWER T, FRANKE U, FEHRENBACH A, et al. Impact of retrograde graft preservation in Perfadex-based experimental lung transplantation [J]. Journal of Surgical Research,2004,117(2):239-48.
[43]胡春晓,郑明峰,王雁娟,et al.体外膜肺氧合在临床肺移植中的应用[J].中华器官移植杂志,2011,32(10)：611-3.
[44]MURTHY S C, GILDEA T R, MACHUZAK M S. Anastomotic airway complications after lung transplantation [J]. Current Opinion in Organ Transplantation,2010,15(5):582-7.
[45]INCI I, WEDER W. Airway complications after lung transplantation can be avoided without bronchial artery revascularization [J]. Current Opinion in Organ Transplantation,2010,15(5):578-81.
[46]LAU C L, PATTERSON G A, PALMER S M. Critical care aspects of lung transplantation [J]. Journal of Intensive Care Medicine,2004,19(2):83-104.
[47]CHATILA W M, FURUKAWA S, GAUGHAN J P, et al. Respiratory failure after lung transplantation [J]. CHEST Journal,2003,123(1):165-73.
[48]胡春晓,朱艳红,陈静瑜,et al.机械通气在肺移植术后的临床应用[J].中国危重病急救医学,2004,24(6)：468-9.
[49]SAJJAN U, COREY M, HUMAR A, et al. Immunolocalisation of Burkholderia cepacia in the lungs of cystic fibrosis patients [J]. Journal of Medical Microbiology, 2001,50(6):535-46.
[50]IVERSEN M, BURTON C, VAND S, et al. Aspergillus infection in lung transplant patients:incidence and prognosis [J]. European Journal of Clinical Microbiology & Infectious Diseases,2007,26(12):879-86.
[51]AVERY R K. Antifungal prophylaxis in lung transplantation; proceedings of the Seminars in respiratory and critical care medicine, F,2011 [C].(?) Thieme Medical Publishers.
[52]KOTLOFF R, AHYA V. Medical complications of lung transplantation [J]. European Respiratory Journal,2004,23(2):334-42.
[53]MEHRAD B, PACIOCCO G, MARTINEZ F J, et al. Spectrum of Aspergillus infection in lung transplant recipientsCase series and review of the literature [J]. CHEST Journal,2001,119(1):169-75.
[54]NIEDERMAN M S, CRAVEN D, BONTEN M, et al. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia [J]. Am J Respir Crit Care Med,2005,171(4): 388-416.
[55]LEVINE S M. A survey of clinical practice of lung transplantation in North America [J]. CHEST Journal,2004,125(4):1224-38.
[56]KRUGER R M, PARANJOTHI S, STORCH G A, et al. Impact of prophylaxis with cytogam alone on the incidence of CMV viremia in CMV-seropositive lung transplant recipients [J]. The Journal of Heart and Lung Transplantation,2003, 22(7):754-63.
[57]DUMMER J S, LAZARIASHVILLI N, BARNES J, et al. A survey of anti-fungal management in lung transplantation [J]. The Journal of Heart and Lung Transplantation,2004,23(12):1376-81.
[58]KNOOP C, HAVERICH A, FISCHER S. Immunosuppressive therapy after human lung transplantation [J]. European Respiratory Journal,2004,23(1):159-71.
[59]PALMER S M, MIRALLES A P, LAWRENCE C M, et al. Rabbit antithymocyte globulin decreases acute rejection after lung transplantationresults of a randomized, prospective study [J]. CHEST Journal,1999,116(1):127-33.
[60]KRASINSKAS A M, KREISEL D, ACKER M A, et al. CD3 monitoring of antithymocyte globulin therapy in thoracic organ transplantation [J]. Transplantation,2002,73(8):1339-41.
[61]BROCK M V, BORJA M C, FERBER L, et al. Induction therapy in lung transplantation:a prospective, controlled clinical trial comparing OKT3, anti-thymocyte globulin, and daclizumab [J]. The Journal of heart and lung transplantation:the official publication of the International Society for Heart Transplantation,2001,20(12):1282-90.
[62]MEIER-KRIESCHE H U, LI S, GRUESSNER R W G,et al. Immunosuppression: Evolution in Practice and Trends,1994-2004 [J]. American Journal of Transplantation,2006,6(5p2):1111-31.
[63]HELDERMAN J H, BENNETT W M, CIBRIK D M, et al. Immunosuppression: practice and trends [J]. American Journal of Transplantation,2003,3(s4):41-52.
[64]KRISHNAM M S, SUH R D, TOMASIAN A, et al. Postoperative Complications of Lung Transplantation:Radiologic Findings along a Time Continuum1 [J]. Radiographics,2007,27(4):957-74.
[1]Fire, A., S. Xu, et al. (1998). "Potent and specific genetic interference by double-stranded RNA in Caenorhabditis elegans." Nature 391(6669):806-811.
[2]He, L. and G. J. Hannon (2004). "MicroRNAs:small RNAs with a big role in gene regulation." Nat Rev Genet 5(7):522-531.
[3]Bernstein, E., S. Y. Kim, et al. (2003). "Dicer is essential for mouse development." Nat Genet 35(3):215-217.
[4]Williams, A. (2008). "Functional aspects of animal microRNAs." Cellular and Molecular Life Sciences 65(4):545-562.
[5]Stefani, G. and F. J. Slack (2008). "Small non-coding RNAs in animal development." Nat Rev Mol Cell Biol 9(3):219-230.
[6]Sonkoly, E., T. Wei, et al. (2007). "MicroRNAs:novel regulators involved in the pathogenesis of psoriasis?" PLoS ONE 2(7).
[7]Jopling, C. L., M. Yi, et al. (2005). "Modulation of Hepatitis C Virus RNA Abundance by a Liver-Specific MicroRNA." Science 309(5740):1577-1581.
[8]Chen, C.-Z. and H. F. Lodish (2005). "MicroRNAs as regulators of mammalian hematopoiesis." Seminars in Immunology 17(2):155-165.
[9]S. Ikeda, S.W. Kong, J. Lu, E. Bisping, H. Zhang and P.D. Allen et al., Altered microRNA expression in human heart disease, Physiol Genomics 31 (2007), pp. 367-373.
[10]J. Lu, G. Getz, E.A. Miska, E. Alvarez-Saavedra, J. Lamb and D. Peck et al., MicroRNA expression profiles classify human cancers, Nature 435 (2005), pp. 834-838
[11]A. Care, D. Catalucci, F. Felicetti, D. Bonci, A. Addario and P. Gallo et al., MicroRNA-133 controls cardiac hypertrophy, Nat Med 13 (2007), pp.613-618.
[12]Sheedy, F. J. and L. A. J. O'Neill (2008). "Adding fuel to fire:microRNAs as a new class of mediators of inflammation." Annals of the Rheumatic Diseases 67(Suppl 3):iii50-iii55.
[13]C.Z. Chen et al., MicroRNAs modulate hematopoietic lineage differentiation, Science 303 (2004), pp.83-86.
[14]Shivdasani, R. A. (2006). "MicroRNAs:Regulators of gene expression and cell differentiation." Blood 108(12):3646-3653.
[15]Neilson, J. R., G. X. Y. Zheng, et al. (2007). "Dynamic regulation of miRNA expression in ordered stages of cellular development." Genes and Development 21(5):578-589.
[16]Li, Q. J., J. Chau, et al. (2007). "miR-181a Is an Intrinsic Modulator of T Cell Sensitivity and Selection." Cell 129(1):147-161.
[17]Ebert, P. J. R., S. Jiang, et al. (2009). "An endogenous positively selecting peptide enhances mature T cell responses and becomes an autoantigen in the absence of microRNA miR-181a." Nat Immunol 10(11):1162-1169.
[18]Mustelin, T., T. Vang, et al. (2005). "Protein tyrosine phosphatases and the immune response." Nature Reviews Immunology 5(1):43-57.
[19]Fazi, F., A. Rosa, et al. (2005). "A minicircuitry comprised of microRNA-223 and transcription factors NFI-A and C/EBPa regulates human granulopoiesis." Cell 123(5):819-831.
[20]Johnnidis, J. B., M. H. Harris, et al. (2008). "Regulation of progenitor cell proliferation and granulocyte function by microRNA-223." Nature 451(7182): 1125-1129.
[21]Monticelli, S., K. M. Ansel, et al. (2005). "MicroRNA profiling of the murine hematopoietic system." Genome biology 6:R71
[22]Wu, H., J. R. Neilson, et al. (2007). "miRNA profiling of naive, effector and memory CD8 T cells." PLoS ONE 2:e1020
[23]Zhou, B., S. Wang, et al. (2007). "miR-150, a microRNA expressed in mature B and T cells, blocks early B cell development when expressed prematurely." Proceedings of the National Academy of Sciences of the United States of America 104(17):7080-7085.
[24]Xiao, C., D. P. Calado, et al. (2007). "MiR-150 Controls B Cell Differentiation by Targeting the Transcription Factor c-Myb." Cell 131(1):146-159.
[25]Xiao, C., L. Srinivasan, et al. (2008). "Lymphoproliferative disease and autoimmunity in mice with increased miR-17-92 expression in lymphocytes." Nature Immunology 9(4):405-414.
[26]Thai, T. H., D. P. Calado, et al. (2007). "Regulation of the germinal center response by MicroRNA-155." Science 316(5824):604-608.
[27]Rodriguez, A., E. Vigorito, et al. (2007). "Requirement of bic/microRNA-155 for normal immune function." Science 316(5824):608-611.
[28]Rao, D. S., R. M. O'Connell, et al. (2010). "MicroRNA-34a Perturbs B Lymphocyte Development by Repressing the Forkhead Box Transcription Factor Foxpl." Immunity 33(1):48-59.
[29]Taganov, K. D., M. P. Boldin, et al. (2006). "NF-κB-dependent induction of microRNA miR-146, an inhibitor targeted to signaling proteins of innate immune responses." Proceedings of the National Academy of Sciences of the United States of America 103(33):12481-12486.
[30]Akira, S. and K. Takeda (2004). "Toll-like receptor signalling." Nature Reviews Immunology 4(7):499-511.
[31]O'Connell, R. M., K. D. Taganov, et al. (2007). "MicroRNA-155 is induced during the macrophage inflammatory response." PNAS 104(5):1604-1609.
[32]Tili, E., J. J. Michaille, et al. (2007). "Modulation of miR-155 and miR-125b levels following lipopolysaccharide/TNF-α stimulation and their possible roles in regulating the response to endotoxin shock." Journal of Immunology 179(8): 5082-5089.
[33]Moschos, S. A., A. E. Williams, et al. (2007). "Expression profiling in vivo demonstrates rapid changes in lung microRNA levels following lipopolysaccharide-induced inflammation but not in the anti-inflammatory action of glucocorticoids." BMC Genomics 8.
[34]Perry, M. M., S. A. Moschos, et al. (2008). "Rapid Changes in MicroRNA-146a Expression Negatively Regulate the IL-1β-Induced Inflammatory Response in Human Lung Alveolar Epithelial Cells." J Immunol 180(8):5689-5698.
[35]Ceppi, M., P. M. Pereira, et al. (2009). "MicroRNA-155 modulates the interleukin-1 signaling pathway in activated human monocyte-derived dendritic cells." PNAS 106(8):2735-2740.
[36]Asangani, I. A., S. A. K. Rasheed, et al. (2007). "MicroRNA-21 (miR-21) post-transcriptionally downregulates tumor suppressor Pdcd4 and stimulates invasion, intravasation and metastasis in colorectal cancer." Oncogene 27(15): 2128-2136.
[37]Loffler, D., K. Brocke-Heidrich, et al. (2007). "Interleukin-6 dependent survival of multiple myeloma cells involves the Stat3-mediated induction of microRNA-21 through a highly conserved enhancer." Blood 110(4):1330-1333.
[38]Stittrich, A.-B., C. Haftmann, et al. (2010). "The microRNA miR-182 is induced by IL-2 and promotes clonal expansion of activated helper T lymphocytes." Nat Immunol 11(11):1057-1062.
[39]Sui, W., Y. Dai, et al. (2008). "Microarray analysis of MicroRNA expression in acute rejection after renal transplantation." Transplant Immunology 19(1):81-85.
[40]Anglicheau, D., V. K. Sharma, et al. (2009). "MicroRNA expression profiles predictive of human renal allograft status." Proceedings of the National Academy of Sciences 106(13):5330-5335.
[41]Sotolongo, B., T. Asaoka, et al. "Gene Expression Profiling of MicroRNAs in Small-Bowel Transplantation Paraffin-Embedded Mucosal Biopsy Tissue." Transplantation Proceedings 42(1):62-65.
[42]Krutzfeldt,J., N. Rajewsky, et al. (2005). "Silencing of microRNAs in vivo with /'antagomirs/'."Nature 438(7068):685-689.
[43]Brown, B. D. and L. Naldini (2009). "Exploiting and antagonizing microRNA regulation for therapeutic and experimental applications." Nat Rev Genet 10(8): 578-585.
[44]Lanford, R. E., E. S. Hildebrandt-Eriksen, et al. (2010). "Therapeutic Silencing of MicroRNA-122 in Primates with Chronic Hepatitis C Virus Infection." Science 327(5962):198-201.
[45]Kota, J., R. R. Chivukula, et al. (2009). "Therapeutic microRNA Delivery Suppresses Tumorigenesis in a Murine Liver Cancer Model." Cell 137(6): 1005-1017.