RÉSUMÉ
Rejection after lung transplantation, including acute rejection (AR) and chronic rejection manifested with chronic lung allograft dysfunction (CLAD), is the main factor affecting the long-term survival of allografts. Exosome, a type of extracellular nanovesicle for intercellular communication among eukaryotic cells, could carry complex biological information and participate in various physiological and pathological processes. Exosome has become a critical immune medium in rejection, regulates the incidence and development of rejection through multiple pathways, and also plays a key role in the monitoring and management of rejection. In this article, the type of rejection after lung transplantation, the mechanism underlying the role of exosome in regulating rejection, exosome acting as biomarkers and the application in rejection treatment were reviewed, aiming to provide a novel direction for comprehensive diagnosis and treatment of rejection following lung transplantation.
RÉSUMÉ
Chronic lung allograft dysfunction (CLAD) is the largest obstacle to the long-term survival of lung transplant recipients, which represents a series of complicated clinical manifestations of significant and persistent deterioration of lung allograft function after surgery. Due to lack of effective strategies for early diagnosis and prevention, over half of lung transplant recipients will develop CLAD within postoperative 5 years, which is likely to increase to 75% within postoperative 10 years. At present, no drug can be administered to completely prevent or reverse the progression of CLAD. In recent years, since the definition, diagnosis and treatment of CLAD have been updated by International Society of Heart and Lung Transplantation (ISHLT) in 2019, the understanding of CLAD has been significantly deepened within the international community. In this article, comprehensive diagnostic methods and potential treatment strategies of CLAD were explicitly illustrated, aiming to provide theoretical reference and insights for early monitoring and management of the incidence and progression of CLAD.
RÉSUMÉ
El trasplante pulmonar es una opción terapéutica válida para mejorar la sobrevida de pacientes con enfermedades respiratorias en fase avanzada. La supervivencia tras el trasplante de pulmón ha mejorado en gran medida como resultado de los avances en la técnica quirúrgica, la cuidadosa preservación de órganos de donantes, las mejoras en la terapia inmunosupresora y el reconocimiento precoz de complicaciones con el uso de técnicas de imagen. Nuestro objetivo es proporcionar una guía radiológica del rechazo agudo y crónico del trasplante pulmonar. Se describirán los hallazgos por tomografía computada multidetector (TCMD).
Lung transplantation is a valid therapeutic option to prolong survival in patients with end-stage pulmonary disease. Survival after lung transplantation has greatly improved as a result of advances in surgical techniques, careful preservation of donor organs, progress in immunosuppressive therapy, and the use of imaging techniques for an early recognition of complications. Our goal is to provide a radiology guide of acute and chronic rejection of lung transplants. The fndings of multidetector computed tomography (MDCT) studies are described.