Research Project to Establish the Clinical Indication and the Way for Safe Management of the Graft in Lung and Heart-Lung Transplantation.

1.保存：保存液中具有缓冲作用的胞外成分和温度都是影响保存的重要因素。吸入一氧化氮可改善保存的移植物功能。为了评估保存的移植物的功能，测量滤过系数或肺泡液清除率可能是有用的。再移植反应：尿司他丁、g-羟基丁酸盐、硫氧还蛋白、a受体阻滞剂对移植后肺水肿均有保护作用，提示再灌注损伤与自主神经去支配参与了这一现象。排斥反应和免疫抑制：对供体皮肤成纤维细胞的细胞毒性试验是检测犬肺移植急性排斥反应的有效方法，细胞毒性指数与肺移植单核细胞浸润程度有关。更重要的是，测量一氧化氮浓度可能是有用的，因为浓度的增加与排斥反应的病理分级有关。供体来源的扩大：在灵长类动物序贯双侧肺移植模型中，脑死亡、无心脏跳动供体的肺移植被证明是可能的。非心脏供体肺移植将扩大供体标准的适应证，导致供体来源增加。在异种移植领域，通过给药抗t细胞受体抗体，可以诱导小鼠和大鼠心脏移植模型的耐受。受体标准：对14例弥漫性肺疾病患者从吸氧起始点到死亡的时间进行评估，以确定合适的移植点。虽然需要进一步的经验，但假设补充氧气的起始点适合于登记，因为大多数病例在3年内死亡。少

1.Preservation : It was demonstrated that extracellular composition with buffer action of preservation solution and temperature were both quite important factors in preservation. Nitric oxide inhalation proved to improve the function of preserved graft. To evaluate the function of preserved graft, measurement of filtration coefficient or pulmonary alveolar fluid clearance were likely to be useful.2.Reimplantation response : Urinastatin, g-hydroxybutylate, thioredoxin, a-blocker were found to have protective effects on posttransplantation pulmonry edema, suggesting that not only the reperfusion injury but also the autonomic denervation participated in this phenomenon.3.Rejection and immunosuppression : Cytotoxicity test against donor skin fibroblast were useful method to detect (100) acute rejection in canine lung transplantation, and the extent of the mononuclear cell infiltration in pulmonary allograft correlated to the value of cytotoxicity index. To monitor rejection in lung transpl … More antation, measurement of nitric oxide gas concentration is likely to be useful since the increase in the concentration of that was correlated with the pathological grading of rejection.4.Expansion of the donor source : Lung transplantation from the brain-dead, non-heart-beating donor was demonstrated to be possible in the primate sequential bilateral lung transplantation model. Lung transplantation from non-heart-beating donor will expand the indication of the donor criteria, resulting in the increase of donor source. In the field of xenotransplantation, the possibility to induce the tolerance in concordant heart transplantation model between mouse and rat was shown with the administration of anti-T-cell receptor antibody.5.Recipient criteria : To determine the appropriate point for transplantstion, the term from the starting point of oxygen inhalation to death was evaluated in 14 cases with diffuse pulmonary diseases. Although further (200) experience is necessary, it was postulated that the starting point of oxygen supplement was appropriate for the registration since most cases had died within 3 years from that point. Less