Implementation of a living-related organ donation program in clinical lung transplantation: role of psychological, physiologic and immunologic parameters

活体供体肺移植可以缓解供体器官短缺，提供更好的人类白细胞抗原配型，并可以进行旨在故意诱导移植耐受的预处理方案。本文描述的项目的目的是评估在新实施的临床方案中接受活体肺移植的年轻患者的心理、生理和免疫学参数。对照组患者将接受年龄匹配的身体肺。纵向评估的心理参数将包括对与健康有关的生活质量的感知、焦虑和抑郁的迹象和症状，以及人际和家庭应对策略。生理参数包括常规肺功能测试(VCmax、FEV1)、呼出的一氧化氮分析、血气分析(动脉和/或毛细血管)、胸部X线片、支气管镜下的支气管肺泡静脉和测压试验。免疫学参数将被评估，以试图表征T细胞介导的同种异体抗原调节机制。这包括用于白细胞群体表型分析的FACS分析和基于玻片的细胞术，以及用于T细胞调节功能分析的混合淋巴细胞反应分析。我们假设，与身体肺的对照受体相比，活体供体肺移植将导致上述多项参数的改善。总之，活体供体肺移植计划的实施将使这一程序首次在欧洲移植区可用，为该项目中描述的计划的科学监测开辟了令人兴奋的前景。

Living donor lung transplantation could alleviate the donor organ shortage, could provide improved HLA-matching and could enable pretreatment protocols aimed at the deliberate induction of transplantation tolerance. The aim of the herein described project is to evaluate psychological, physiologic and immunologic parameters in young patients undergoing livingrelated lung transplantation in a newly implemented clinical program. Control patients will be age-matched recipients of cadaver lungs. Psychological parameters to be evaluated longitudinally will comprise perception of health-related quality of life, signs and symptoms of anxiety and depression, and interpersonal and familial coping strategies. Physiologic parameters include routine lung function tests (VCmax, FEV1), analyses of exhaled nitric oxide, blood gas analyses (arterial and/or capillary), chest radiographs, bronchoscopies with bronchoalveolar Javages and ergospirometry tests. Immunologic parameters will be evaluated in an attempt to characterize T cell-mediated mechanisms of alloantigen-regulation. This includes FACS-assays and slide based cytometry for phenotype analyses of leukocyte population, and mixed lymphocyte reaction assays for functional analyses of T cell regulation. We hypothesize that living donor lung transplantation will lead to improvements of multiple of the aforementioned parameters as compared to control recipients of cadaver lungs. In conclusion, the implementation of a living donor lung transplantation program will make this procedure available in the Eurotransplant zone for the first time, opening exciting prospects for the scientific monitoring of the program described in this project.