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

活体供肺移植可以缓解供体器官短缺，提供更好的hla匹配，并且可以实现旨在故意诱导移植耐受的预处理方案。本文所述项目的目的是在一个新实施的临床项目中评估接受活体肺移植的年轻患者的心理、生理和免疫参数。对照患者将是年龄匹配的尸体肺接受者。纵向评估的心理参数将包括对健康相关生活质量的感知、焦虑和抑郁的体征和症状，以及人际和家庭应对策略。生理参数包括常规肺功能检查（VCmax、FEV1）、呼出一氧化氮分析、血气分析（动脉和/或毛细血管）、胸片、支气管肺泡镜检查和肺活量测定试验。免疫学参数将被评估，试图表征T细胞介导的异体抗原调节机制。这包括用于白细胞群表型分析的facs测定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测定。我们假设，活体供体肺移植将导致多个上述参数的改善，而不是尸体肺的对照接受者。总之，活体供体肺移植计划的实施将使该程序首次在欧洲移植区可用，为本项目中描述的程序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.