解决肺移植中供体器官短缺的策略

摘要(中文译文)

肺移植仍然受到供体器官短缺的限制。本综述总结了近期具有直接扩大肺源可及性潜力的策略，包括10°C低温保存、循环死亡后捐献（DCD）、离体肺灌注（EVLP）以及扩大老年供体的利用。10°C静态保存的临床转化已使延长保存时间成为可能，包括保存长达24小时而无明显短期或中期不良后果，并有望实现半择期移植。当代证据支持更广泛地使用DCD肺，尤其是可控性DCD，尽管在某些队列中早期风险存在微小差异，但长期结局令人安心；不可控性DCD在高度组织化的基于EVLP的项目中仍具前景，而胸腹常温区域灌注则需要进一步的前瞻性评估。EVLP持续提高边缘供肺的利用率，最大的单中心系列报告其结局与常规移植相当。与此同时，经过仔细筛选的七十多岁甚至八十多岁/九十多岁供体已显示出令人鼓舞的短期和长期临床结局。肺移植中的供体短缺可通过结合延长物流的保存策略、更广泛的供体途径、先进的移植物评估以及谨慎扩大供体接受标准来缓解。标准化、前瞻性、多中心临床试验仍然常常缺乏，是未来需要改进的领域。

Abstract

Lung transplantation remains limited by donor organ scarcity. This review summarizes recent strategies with the direct potential to expand lung availability, including 10°C hypothermic preservation, donation after circulatory death (DCD), ex vivo lung perfusion (EVLP), and expanded utilization of elderly donors. Clinical translation of 10°C static preservation has enabled prolonged storage, including preservation for up to 24 h without clear adverse short- or intermediate-term consequences, and the prospect of semi-elective transplantation. Contemporary evidence supports broader use of DCD lungs, particularly controlled DCD, with reassuring long-term outcomes despite small differences in early risk in some cohorts; uncontrolled DCD remains promising in highly organized EVLP-based programs, whereas thoracoabdominal normothermic regional perfusion requires further prospective evaluation. EVLP continues to increase utilization of marginal lungs, and the largest single-center series reported outcomes comparable to conventional transplantation. In parallel, carefully selected septuagenarian and even octo-/nonagenarian donors have demonstrated encouraging short- and long-term clinical outcomes. Donor shortage in lung transplantation can be mitigated by combining logistics-extending preservation strategies, broader donor pathways, advanced graft assessment, and careful expansion of donor acceptance criteria. Standardized, prospective, multicenter clinical trials are still frequently lacking and represent an area for future improvement.

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