天美传媒

miR-424; Transplantation; Bacteremia; Acute rejection

Introduction

Thoracic transplantation refers to the surgical procedure of replacing damaged or diseased heart, lungs, or both with a healthy heart, lungs, or both from a donor. The first successful heart transplant was performed in 1967 by Dr. Christian Barnard in Cape Town, South Africa. Since then, this field has made tremendous progress, and thoracic transplantation has become a standard treatment option for various end-stage cardiac and pulmonary diseases [1]. In this review, we will discuss the various aspects of thoracic transplantation, including indications, evaluation process, surgical techniques, immunosuppression, complications, and outcomes. Many people currently consider thoracic epidural analgesia to be the “gold standard” for managing postoperative pain in lung transplant patients [2]. Albeit numerous perceive TEA as a fundamental piece of postoperative absense of pain for those getting lung transfers, some are worried about careful postponement because of an opportunity to put a TEA and epidural hematoma development with the fundamental anticoagulation required for cardiopulmonary detour. Postoperative epidural situation may forestall these dangers, yet coordination, new coagulopathy after transplantation, as well as trouble with patient situating presents calculated difficulties [3]. This was a case-control concentrate on that looked at 52 patients requiring TEA post−lung relocate with 644 patients who did not need TEA postrelocate. Regardless of the implied benefits of TEA for postoperative agony control in lung transplantation, just 7.4% of patients in this partner required postoperative TEA [4].

This suggests that only a select group of lung transplant patients may benefit from conservative use of TEA. A history of substance abuse, previous thoracic surgery, and bilateral graft placement may be characteristics of this group, according to our multivariate findings [5].

Method

This study recognized a few gamble factors for serious postoperative torment requiring TEA including a past filled with discouragement, nervousness, substance use, earlier thoracic medical procedure, reciprocal lung transplantation, and the utilization of narcotics, antidepressants, anticonvulsants, and lidocaine patches preoperatively. Thoracotomy incision, young age, and bilateral lung transplantation were also found to be risk factors for severe postoperative pain in a previous study [6]. Conversely, our review didn’t track down a relationship among’s age and need for TEA, yet our review certified the observing that respective transplantation is a gamble factor for expanded torment. The fact that we were unable to extract the type of incision from our database was one of the study’s limitations [7]. As a result, we are unable to compare our findings to the previous finding that thoracotomy causes more pain. The training at our foundation is for the most part thoracotomy for single lung relocate and clamshell for respective transfer, for certain special cases [8].

Indications

The indications for thoracic transplantation depend on the specific organ involved. Heart transplantation is indicated in patients with end-stage heart failure refractory to medical management. Lung transplantation is indicated in patients with end-stage lung disease, such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), and pulmonary hypertension (PH). Heart-lung transplantation is indicated in patients with end-stage disease of both organs [9].

Evaluation Process

The evaluation process for thoracic transplantation involves a comprehensive assessment of the patient’s medical history, physical examination, laboratory tests, imaging studies, and psychosocial evaluation. The evaluation process aims to identify potential contraindications, such as active infections, malignancy, severe liver or kidney disease, and psychosocial issues that may affect the patient’s ability to comply with post-transplant care. The evaluation process also helps to determine the patient’s candidacy for transplantation based on factors such as age, comorbidities, and the severity of the underlying disease [10].

Surgical Techniques

The surgical technique for thoracic transplantation varies depending on the specific organ involved. Heart transplantation involves harvesting the donor heart and implanting it into the recipient’s chest, connecting the new heart’s blood vessels to the recipient’s blood vessels and connecting the donor’s heart valves to the recipient’s native valves. In contrast, lung transplantation involves removing the native lungs and implanting the donor lungs, connecting the donor’s bronchi to the recipient’s trachea and the donor’s pulmonary arteries and veins to the recipient’s pulmonary vessels. Heart-lung transplantation involves removing the native heart and lungs and implanting the donor heart and lungs, connecting the donor’s blood vessels, and bronchi to the recipient’s blood vessels and trachea [11].

Immunosuppression

Immunosuppression is a critical component of thoracic transplantation, as it prevents rejection of the transplanted organ by the recipient’s immune system. The immunosuppressive regimens used in thoracic transplantation typically include a combination of drugs such as calcineurin inhibitors, antimetabolites, and corticosteroids. The immunosuppressive regimens aim to achieve a balance between preventing rejection and minimizing side effects such as infections and malignancies [12].

Complications

Thoracic transplantation is associated with several complications, such as infection, rejection, malignancy, and cardiovascular complications. Infection is a common complication in the early posttransplant period due to immunosuppression. Rejection occurs when the recipient’s immune system recognizes the transplanted organ as foreign and attacks it. Rejection can be acute or chronic and can occur at any time after transplantation. Malignancies are also a significant concern in long-term survivors of thoracic transplantation due to immunosuppression. Cardiovascular complications, such as coronary artery disease and hypertension, are also common in long-term survivors.

Outcomes

The outcomes of thoracic transplantation have improved significantly over the years, with 1-year survival rates of more than 80% for heart and lung transplantation and 70% for heart-lung transplantation. The long-term survival rates of thoracic transplantation are lower, with 5-year survival rates of approximately 50% for heart and lung transplantation and 40% for heart-lung transplantation. The outcomes of thoracic transplantation are influenced by several factors such as the underlying disease, the patient’s age and comorbidities, the surgical technique, the immunosuppressive regimen, and the incidence of complications.

Discussion

Additionally, we investigated commonly measured postoperative outcomes in lung transplant patients. When the rates of postoperative delirium, days on mechanical ventilation, ICU stay, and hospital stay were measured, there were no significant differences between the two groups. Consequently, the use of a TEA does not appear to hinder recovery by adding an additional patient device that needs to be weaned and removed, nor does it appear to accelerate recovery through faster pain control.

Patients who received TEA had shorter hospital stays, shorter periods of mechanical ventilation, and better pain management, according to one study by McLean et al. Our review didn’t show any of these advantages for patients getting TEA and this may be because of the reality that we utilized a salvage epidural strategy, though the other review set epidurals preoperatively. The use of a single center, retrospective data collection, and a significant difference in sample size between the two cohorts are some of the limitations of this study. To support these findings, additional research is required that looks at prospective data collection and expansion to other high-volume lung transplant centers.

Conclusion

Thoracic transplantation is a complex and challenging surgical procedure that provides a life-saving option for patients with endstage cardiac and pulmonary diseases. The success of thoracic transplantation depends on careful selection of candidates, appropriate surgical techniques, effective immunosuppression, and management of complications. Advances in this field have led to improved outcomes, and thoracic transplantation has become an essential treatment option for end-stage cardiac and pulmonary diseases. TEA placement appears to be safe for lung transplant patients, despite the limited evidence. In 2015, a case series of 119 patients by Carson et al. showed that TEA placement for lung transplantation did not cause any serious complications, although 6.7% of patients experienced postoperative pulmonary compromise. Retrospective reviews conducted by Axtell and McClean revealed adequate safety profiles and potential, but not definitive, improvements in postoperative pain control. Thoracotomy incision, young patient age, and bilateral lung transplantation are known risk factors for poor pain control following lung transplantation. Realized risk factors for postoperative agony incorporate youthful age, uneasiness, female sex, history of smoking, burdensome side effects, unfortunate rest, high weight list, and preoperative pain relieving prerequisites. Patients undergoing lung transplantation do not typically require TEA placement at UCLA, but these patients may require it due to inadequate postoperative pain control. This considers the chance to concentrate on the gamble factors related with salvage TEA situation in this careful populace. At a single academic center, the primary objective is to identify risk factors for postoperative TEA placement in lung transplant patients. The optional point of this study is to look at results between lung transplantation patients who got postoperative TEA situation and the people who didn’t.

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