1. 肺移植国内外进展 陈静瑜 卫生部肺脏移植数据中心 江苏省肺移植中心 无锡市人民医院

2. Lung Transplant History First experimental operation: 1950-54 Metras, Hardin First human operation: 1963 Hardy Recipient:58-yr-old man, emphysema Donor: MI, shock - ER left single lung Tx Background ：Lung Transplantation

3. Background ：Lung Transplantation

4. 1st Success 1983 - Toronto Lung Transplant Group 58 yr old male, IPF Survived 7 years Died of kidney failure caused by anti-rejection medication Background ：Lung Transplantation

5. En Bloc Double Lung Dark (1986) experimental technique (canine) 1986 Patterson et al. - first successful en bloc double lung transplant (Alive today) Donor airway ischemia still a problem Background ：Lung Transplantation

6. Sequential Double Lung Pasque et al. Wash U. Bilateral sequential lung transplantation emerged in 1989 May avoid CPB. No need for cardioplegia Reduced bronchial anastomotic problems Background ：Lung Transplantation

7. Background ：Lung Transplantation Living-donor lobar lung transplantation was introduced by Starnes and colleagues in 1991 Recipient (son) PPH Donor (mother) right lower lobe

8. The Registry of the International Society for Heart andLung Transplantation: Twenty-seventh official adult lungand heart-lung transplant report Background ：Lung Transplantation 2010 ISHLT

9. NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants performed worldwide. ISHLT 2010

10. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2008) ISHLT 2010

11. ADULT LUNG TRANSPLANTATION: Indications(1/1995-6/2009) ISHLT 2010

12. ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year ISHLT 2010

13. ADULT LUNG TRANSPLANTATIONKaplan-Meier survival by diagnosis (Transplants: January 1988 – June 2008) ISHLT 2010

14. ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death(Deaths: January 1992- June 2009) ISHLT 2010

15. Transport from A to B Donor Lung Flushing to remove blood, preservation Questions: Tm, Time, solution inflation? Reperfusion Questions: Rate, pressure, ventilation, etc Transplantation Question: How to do the operation

16. Barriers to Success shortage of donors waiting list mortality PGD acute rejection BOS.

18. NovaLungBridge to Lung Transplantation

20. NovaLung

22. Deceased Donors • Current – largest, best source of donor lungs • We have NOT maximized utilization • Need to improve utilization: • Manage donors better • Develop better strategies to predict post transplant lung function • Strategies to assess lungs (ex-vivo) • Strategies to “repair” donor lungs

23. Donor Lung Ex-vivo Assessment and Treatment Physiologic Assessment Fails Excellent Biologic Assessment Excellent TRANSPLANT

24. DONOR LUNG Ex-vivo Assessment and Treatment Physiologic Assessment Fails Fails Excellent Gene Therapy, Other Repair Strategies Biologic Assessment Reassess Fails Excellent TRANSPLANT No Transplant

25. Lung Transplantation in China First stage 1978 Dr.Xing Yu-ling , first SLTx for TB in China, died 1995Dr. Chen Yu-ping SLTx for IPF survived 1998 Dr. Chen Yu-ping BLTx for PPH with CPB urvived

26. 1978 Dr.Xing Yu-ling first SLTx for TB in China,

27. Dr. Chen Yu-ping 1995-2-23, SLTx for IPF survived 5y10m 1998-1-20, BLTx for PPH with CPB, survived 4y3m Background ：Lung Transplantation

28. From 1994 to 1998 , about 20 cases were performed, only 2 patients survived. The LTx stoped in China from 1998-Sep.2002 because of low survival rate.

29. Second stage Since the SLTx for COPD was performed by Wuxi Group on Sep. 2002, remarkable progress have be achieved in China.

30. 器官移植学会登记处各种器官移植统计 *数据主要来源于各移植数据中心

33. Number of lung transplants in China (1978-2010)

36. 本中心

37. Result 1，2，3 , 5 year survive rate is 73.3%,61.6%,53.5%,40.7%.

38. Insision consideration Bilateral anterolateral thoracotomies Clamshell incision (trans-sternal Bilateral thoracotomy incision) Antero muscle sparing thoractomy Minimally invasive technique with VATS

39. Insision consideration

40. Insision consideration

41. Insision consideration

42. Operative technique Bronchial anastomosis Arterial anastomosis Left atrium anastomosis Size discrepancies Unusual circumstance

43. Operative technique

45. Operative technique

46. Operative technique Pulmonary Artery Anastomosis

48. Left Atrial Anastomosis

50. 5.Ventilator dependent recipient 术后病理 术后病理 BSLTx 1st, March 2005