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Lung Transplantation and the Blood–Gas Barrier

  • Anke Schnapper
  • Matthias Ochs
Chapter

Abstract

The blood–gas barrier (BGB) is subjected to a variety of stressors during all the phases of lung transplantation. These result in ischemia-reperfusion (IR) injury and can manifest clinically as primary graft dysfunction (PGD). IR injury affects the epithelium, interstitium, and endothelium of the alveolar septa as well as the pulmonary surfactant system. It leads to functional and morphological damage and death of pulmonary cells, largely due to an inflammatory response by activated resident cells as well as inflammatory cell infiltration, which is governed by a large number of mediators. Since PGD is the major cause of early morbidity and mortality after lung transplantation, much effort is undertaken from organ procurement to preservation and implantation to prevent or ameliorate IR injury, including surgical management procedures and pharmacological additives to perfusion solutions or ventilation gas. In particular, to increase the rate of transplantable donor organs, very promising results are achieved by the new technique of ex vivo lung perfusion (EVLP). Beyond the immediate transplantation period, the BGB is jeopardized in certain forms of acute rejection and chronic lung allograft dysfunction.

Keywords

Lung Transplantation Brain Death Bronchiolitis Obliterans Syndrome Donor Lung Acute Allograft Rejection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations

ALI

Acute lung injury

AMR

Acute antibody-mediated rejection

ARDS

Acute respiratory distress syndrome

BAL

Bronchoalveolar lavage

BGB

Blood-gas barrier

BOS

Bronchiolitis obliterans syndrome

C4d

Complement 4d

CICD

Caspase-independent cell death

CLAD

Chronic lung allograft dysfunction

DBD

Donated after brain death

DCD

Donated after cardiac death

DSA

Donor-specific antibodies

ECMO

Extracorporal membrane oxygenation

EVLP

Ex vivo lung perfusion

FEV1

Forced expiratory volume in 1 s

IR

Ischemia-reperfusion

ISHLT

International Society for Heart and Lung Transplantation

LPD

Low-potassium dextran

NHBD

Non-heart-beating donors

NK

Natural killer cells

NO

Nitric oxide

OB

Obliterative bronchiolitis

PEEP

Positive end-expiratory pressure

PGD

Primary graft dysfunction

PVR

Pulmonary vascular resistance

RAS

Restrictive allograft syndrome

ROS

Reactive oxygen species

SA/LA ratio

Small aggregate to large aggregate ratio

SP

Surfactant protein

TLC

Total lung capacity

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© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Institute of Functional and Applied AnatomyHannover Medical SchoolHannoverGermany

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