Current Status of Lung Transplantation肺移植的.PPTVIP

02. Unmet Medical Need (CM) Current Status of Lung Transplantation Jeff Golden, MD Professor of Clinical Medicine and Surgery Medical Director, Lung TransplantationUniversity of California, San Francisco Current Status of Lung Transplantation Long term survival—50% die by 5 years Bronchiolitis obliterans (chronic rejection)—primary cause of poor survival Future of lung transplantation—prevent bronchiolitis obliterans Lung TransplantationPre-Cyclosporine Era, Pre-1983 Worldwide Lung Transplantation Numbers Comparative Transplantation Survival Rates Clinical Manifestations of Chronic Rejection Two methods for the diagnosis of chronic rejection Histologically through transbronchial biopsy (OB) Clinically through sustained decline in pulmonary function (Bronchiolitis Obliterans Syndrome, BOS) OB and BOS are histologic and clinical manifestations of the same process Patients develop progressive shortness of breath, graft failure, airflow obstruction, recurrent pulmonary infections Once chronic rejection develops, airway damage is progressive and irreversible Patients die of graft failure/pneumonia Causes of Death Following Lung Transplantation Despite Best Current Systemic Treatment and Patient Management, Chronic Rejection Eventually Affects Most Patients New Concept: Avoid Increasing Systemic Immunosuppression Lymphocytic Bronchitis/Bronchiolitis Acute Rejection Separate Interventions for Separate Processes CM-* CM-* Time (days) (4) (12) (19) (28) (38) At risk: 0 50 100 150 200 250 0 20 40 60 80 100 % free from death Source: International Society of Heart and Lung Transplantation (ISHLT); UNOS Lung transplants performed worldwide, by year Emphysema/COPD Idiopathic pulmonary fibrosis Cystic fibrosis Alpha-1 antitrypsin deficiency Primary pulmonary hypertension Sarcoidosis Retransplant/graft failure Other 1.8% 2.6% 4.2% 39.0% 10.4% 17.0% 16.0% 9.0% Primary diagnosis, 01/1995 - 06/2003 1342 1337 1417 1413 1410 1508 1537 1706 1655 1206 106