Souhrn Prezervace dárcovských plic a snaha o bezpečné prodloužení času ischemie při zachování funkce je důležitým tématem, kterému se transplantační komunita věnuje dlouhodobě. Recentní publikace převážně torontského týmu zásadně ovlivňují dosavadní pohled na optimální podmínky prezervace a jejich výsledky představují vědecký základ pro posun od prezervace na ledu ke kontrolované hypotermii. Optimální podmínky prezervace jsou nutnou podmínkou pro bezpečné prodloužení ischemie. To s sebou nese další potenciál pro rozvoj oboru a možnost zlepšení dostupnosti jak samotné metody transplantace plic, tak jejích výsledků. Tento přehledový článek shrnuje zásadní poznatky v oblasti prezervace dárcovských plic od prvních experimentálních pokusů provedených před 30 lety po recentní studie a diskutuje jednotlivé aspekty, které změna standardu prezervace ovlivnila nebo pravděpodobně ovlivní.
Summary The preservation of donor lungs and the effort to safely extend ischemic time while maintaining function is an important topic that the transplant community has been addressing for a long time. Recent publications, mainly from the Toronto team, have fundamentally influenced the existing standard of optimal preservation conditions, and their results provide a scientific basis for the shift from ice preservation to controlled hypothermia. Optimal preservation conditions are a necessary prerequisite for the safe extension of ischemic time. This brings additional potential for the development of the field and the possibility to improve the availability of lung transplantations and their outcomes. This review summarizes the key findings in the area of donor lung preservation from the first experimental attempts conducted 30 years ago to recent studies and discusses the various aspects that the change in preservation standard has influenced or is likely to influence.
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- klinická studie jako téma MeSH
- lidé MeSH
- transplantace plic * MeSH
- uchovávání orgánů * MeSH
- Check Tag
- lidé MeSH
Acute cellular rejection (ACR) frequently occurs following lung transplantation (LuTx) and represents a risk factor for the development of chronic lung allograft dysfunction (CLAD) as well as long-term survival. The histopathological diagnosis of ACR carries a burden of interobserver variability. The widespread utilization and cost-effectiveness of immunohistochemistry (IHC) was proven beneficial in diagnosing rejection in human kidney transplantations and LuTx rat models. However, its potential for ACR detection in patients remains unexplored. We analyzed surface markers (CD3, CD4, CD8, CD20, CD68, CD47, PD-1, PD-L1, and CD31/PECAM-1) on lung tissue cryobiopsy samples collected within 6 months post-LuTx from 60 LuTx recipients, 48 of whom were diagnosed with ACR. Additionally, serum samples from 51 patients were analyzed using a multiplex bead-based Luminex assay. The cytokines and markers included PD-L1, IL2, TNFα, IFNγ, and Granzyme B. We observed a significant increase in PD-L1 tissue expression within the rejection group, suggesting a concerted effort to suppress immune responses, especially those mediated by T-cells. Furthermore, we noted significant differences in PECAM-1 levels between ACR/non-ACR. Additionally, peripheral blood C-reactive-protein levels tended to be higher in the ACR group, while Luminex serum analyses did not reveal any significant differences between groups. In conclusion, our findings suggest the potential value of PECAM-1 and PD-L1 markers in diagnosing ACR.
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- akutní nemoc MeSH
- antigeny CD274 * metabolismus krev MeSH
- antigeny CD31 * metabolismus MeSH
- biologické markery * krev metabolismus MeSH
- dospělí MeSH
- imunohistochemie MeSH
- lidé středního věku MeSH
- lidé MeSH
- plíce patologie MeSH
- rejekce štěpu * diagnóza krev MeSH
- senioři MeSH
- transplantace plic * škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
UNLABELLED: Primary graft failure occurs 15 to 30 % of the time after transplantation. Although there have been improvements in preserving the lungs in good condition, there have not been studies on the regulation of transcription factors. METHODS: We carried out an experimental study involving lung transplantation to indirectly evaluate reactive oxygen species (ROS) production and VEGF expression by competitive blockade of HIF-1alpha with chetomin. There were 5 groups: Group-1: Lung blocks were perfused with 0.9 % SSF, immediately harvested, and preserved. Group-2 (I-T): Immediate transplantation and then reperfusion for 1 h. Group-3 (I-R): Lung blocks were harvested and preserved in LPD solution for 6 h and reperfused for 1 h. Group-4 (DMSO): Lung blocks were treated for 4 h with DMSO, preserved for 6 h and transplanted to a receptor treated with DMSO. Group-5 (chetomin): Lung blocks were treated for 4 h with chetomin, preserved for 6 h and transplanted to a receptor treated with chetomin. ROS, mRNA, and protein levels of HIF-1alpha and EG-VEGF were determined. RESULTS: The DMSO and chetomin groups had significantly lower ROS levels. Compared with those in the I-R group, the chetomin group exhibited the lowest level of HIF-1alpha. CONCLUSIONS: Addition of chetomin to the donor and the receptor results in a significant reduction in HIF-1A, VEGF and ROS.
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- disulfidy MeSH
- faktor 1 indukovatelný hypoxií - podjednotka alfa * metabolismus MeSH
- indolové alkaloidy MeSH
- krysa rodu rattus MeSH
- plíce metabolismus účinky léků MeSH
- potkani Sprague-Dawley MeSH
- reaktivní formy kyslíku * metabolismus MeSH
- transplantace plic * MeSH
- vaskulární endoteliální růstový faktor A * metabolismus MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
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- HIV infekce komplikace MeSH
- infekce dýchací soustavy etiologie imunologie klasifikace komplikace MeSH
- lidé MeSH
- oportunní infekce * etiologie imunologie klasifikace komplikace MeSH
- pneumocystová pneumonie diagnóza etiologie farmakoterapie patologie MeSH
- respirační syncytiální viry patogenita MeSH
- transplantace plic škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
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- intersticiální plicní nemoci * diagnóza terapie MeSH
- lidé MeSH
- progrese nemoci MeSH
- systémová sklerodermie * komplikace terapie MeSH
- transplantace plic MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- bronchoskopie metody MeSH
- kongresy jako téma MeSH
- nemalobuněčný karcinom plic * terapie MeSH
- neoadjuvantní terapie MeSH
- Publikační typ
- zprávy MeSH
Idiopathic pulmonary fibrosis (IPF) is a severe and currently incurable disease that is associated with irreversible fibrotic remodeling of the lung parenchyma. Pathological remodeling of the lung leads to damage of the alveolo-capillary barrier. There is a reduction in the diffusing capacity of the lungs for respiratory gases. Later, changes in the mechanical properties of lung tissue occur - their compliance decreases and respiratory work increases. Impaired respiratory gases exchange with restrictive ventilatory failure lead to tissue hypoxia and muscle weakness. Progressive respiratory insufficiency develops. The triggers of fibrotic remodeling of the lung are currently unknown, as are the pathomechanisms that keep this process active. IPF can only be slowed pharmacologically, not reversed. It is therefore very important to start its treatment as soon as possible. Early detection of IPF patients requires a multidisciplinary approach. Diagnosis, treatment initiation, and monitoring in specialized centers offer the best chance of slowing disease progression, enhancing quality of life, and extending patient survival. In addition to antifibrotic therapy, good lifestyle management, maintenance of physical fitness and treatment of associated chronic diseases such as diabetes and cardiac comorbidities are important. Lung transplantation is an option for some patients with IPF. This is a challenging treatment modality, requiring close collaboration with transplant centers and expert selection of suitable candidates, influenced, among other things, by the availability of suitable donor lungs. Our article aims to provide current information about IPF, focusing on its functional consequences and clinical manifestation. We discuss the molecular and cellular mechanisms potentially involved in IPF development, as well as the morphological changes observed in lung biopsies and high-resolution computed tomography (HRCT) images. Finally, we summarize the existing treatment options. Key words: Idiopathic pulmonary fibrosis, Lung biopsy, HRCT, Antifibrotic therapy, Lung transplantation.
- MeSH
- idiopatická plicní fibróza * terapie diagnóza patofyziologie patologie MeSH
- lidé MeSH
- plíce patologie patofyziologie MeSH
- transplantace plic MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- bronchoalveolární laváž MeSH
- bronchoskopie MeSH
- chybná diagnóza MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- neúspěšná terapie MeSH
- spirometrie MeSH
- tracheomalacie * diagnóza etiologie patologie terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
