Ukufakelwa kabusha kwamaphaphu kuwukwelashwa okwamukelekayo kwesifo esithuthukisiwe samaphaphu. Emashumini ambalwa eminyaka adlule, ukufakelwa kwamaphaphu kuye kwenza inqubekelaphambili emangalisayo ekuhlolweni nasekuhlolweni kwabamukeli bokufakelwa, ukukhethwa, ukulondolozwa kanye nokwabiwa kwamaphaphu anikelayo, amasu okuhlinza, ukuphathwa kwangemva kokuhlinzwa, ukuphathwa kwezinkinga, kanye nokucindezeleka komzimba.
Eminyakeni engaphezu kwengama-60, ukufakelwa kabusha kwamaphaphu kuye kwavela ekwelashweni kokuhlola kuya ekwelashweni okujwayelekile okwamukelekayo kwesifo samaphaphu esisongela ukuphila. Naphezu kwezinkinga ezivamile ezifana nokungasebenzi kahle kokuxhunyelelwa, ukungasebenzi kahle kokufakelwa kabusha kwamaphaphu (i-CLAD), ukwanda kwengozi yokutheleleka ngentuba, umdlavuza, nezinkinga zempilo ezingamahlalakhona ezihlobene nokuvinjelwa kwamasosha omzimba, kunesithembiso sokuthuthukisa ukusinda kwesiguli kanye nezinga lempilo ngokukhethwa komamukeli ofanele. Ngenkathi ukufakelwa kwamaphaphu kuya kuvame kakhulu emhlabeni jikelele, inani lemisebenzi ayikahambisani nesidingo esikhulayo. Lokhu kubuyekezwa kugxile esimeni samanje nentuthuko yakamuva yokufakelwa amaphaphu, kanye namathuba esikhathi esizayo okusetshenziswa ngempumelelo kwalokhu kwelashwa okuyinselele kodwa okungase kuguqule impilo.
Ukuhlolwa nokukhethwa kwabangase babe abamukeli
Ngenxa yokuthi amaphaphu anikelayo afanelekile ayivelakancane, izikhungo zokufakelwa kabusha ziyadingeka ngokwezimiso zokuziphatha ukuze kwabelwe izitho zabanikelayo kulabo abangase babe abamukeli okungenzeka bathole inzuzo enkulu ekutshalweni kabusha. Incazelo evamile yalabo abangaba abamukeli ukuthi banesilinganiso esingaphezu kuka-50% sengozi yokubulawa yisifo samaphaphu phakathi neminyaka engu-2 kanye nethuba elingaphezu kuka-80% lokusinda eminyakeni emi-5 ngemva kokufakelwa kabusha, kucatshangwa ukuthi amaphaphu atshalwe kabusha asebenza ngokugcwele. Izinkomba ezivame kakhulu zokufakelwa kwamaphaphu yi-pulmonary fibrosis, isifo esingamahlalakhona sokuvimbela i-pulmonary, isifo se-pulmonary vascular disease, kanye ne-cystic fibrosis. Iziguli zibhekiselwa ekusetshenzisweni kwamaphaphu okunciphayo, ukuncipha kokusebenza komzimba, nokuqhubeka kwezifo naphezu kokusetshenziswa kakhulu kwemithi nemithi yokwelapha yokuhlinzwa; Ezinye izindlela eziqondene nesifo nazo ziyabhekwa. Izinselele zokubikezela zisekela amasu okudluliselwa kwangaphambi kwesikhathi avumela ukwelulekwa okungcono kwenzuzo engozini ukuze kuthuthukiswe ukwenziwa kwezinqumo okwabelwana ngazo kanye nethuba lokushintsha izithiyo ezingaba khona emiphumeleni ephumelelayo yokufakelwa kabusha. Ithimba lezinhlaka eziningi lizohlola isidingo sokufakelwa amaphaphu kanye nengozi yesiguli yezinkinga zangemva kokufakelwa ngenxa yokusetshenziswa kwezivikeli mzimba, njengengozi yezifo ezingase zibe sengozini yokuphila. Ukuhlolelwa ukungasebenzi kahle kwezitho zamaphaphu, ukuqina komzimba, impilo yengqondo, ukungatheleleki komzimba kanye nomdlavuza kubalulekile. Ukuhlolwa okuqondile kwemithambo ye-coronary kanye ne-cerebral, ukusebenza kwezinso, impilo yamathambo, ukusebenza komphimbo, amandla okusebenza kwengqondo nokusekelwa komphakathi kubalulekile, kuyilapho kuthathwa ukunakekelwa ukuze kugcinwe obala ukuze kugwenywe ukungalingani ekunqumeni ukufaneleka kokufakelwa.
Izinto eziyingozi eziningi ziyingozi kakhulu kunezici eziyingozi eyodwa. Izithiyo zendabuko zokufakelwa kabusha zihlanganisa ukuguga, ukukhuluphala, umlando womdlavuza, ukugula okubucayi, nesifo se-systemic concomitant, kodwa lezi zici zisanda kufakwa inselele. Iminyaka yabamukeli ikhula kancane kancane, futhi ngo-2021, amaphesenti angu-34 wabamukeli e-United States azobe emdala kuneminyaka engama-65, okubonisa ukugcizelela okwandayo kweminyaka yezinto eziphilayo ngaphezu kweminyaka yokulandelana kwezenzakalo. Manje, ngaphezu kwebanga lokuhamba lemizuzu eyisithupha, kuvame ukuba nokuhlolwa okusemthethweni kobuthakathaka, okugxile ezindaweni ezigciniwe ezibonakalayo kanye nezimpendulo ezilindelekile kubacindezeli. Ubuthakathaka buhlotshaniswa nemiphumela engemihle ngemva kokufakelwa amaphaphu, futhi ubuthakathaka ngokuvamile buhlotshaniswa nokwakheka komzimba. Izindlela zokubala ukukhuluphala nokwakheka komzimba ziyaqhubeka nokuguquguquka, kugxilwe kancane ku-BMI nokuningi kokuqukethwe kwamafutha nesisindo semisipha. Amathuluzi athembisa ukulinganisa ukuntengantenga, i-oligomyosis, nokuqina ayathuthukiswa ukuze kubikezelwe kangcono ikhono lokululama ngemva kokufakelwa kwamaphaphu. Ngokuvuselelwa kwamaphaphu ngaphambi kokuhlinzwa, kungenzeka ukuguqula ukwakheka komzimba nokuwohloka, ngaleyo ndlela kube ngcono imiphumela.
Esimeni sokugula okubucayi, ukunquma izinga lokuwohloka nekhono lokululama kuyinselele ikakhulukazi. Ukufakelwa kabusha ezigulini ezithola umoya wokungena ngomshini kwakungavamile ngaphambili, kodwa manje sekuvame kakhulu. Ukwengeza, ukusetshenziswa kokwesekwa kwempilo ye-extracorporeal njengokwelashwa kwezinguquko zangaphambi kokufakelwa kunyukile eminyakeni yamuva nje. Ukuthuthuka kwezobuchwepheshe kanye nokufinyelela emithanjeni kwenze kwaba nokwenzeka ezigulini eziqaphelayo, ezikhethwe ngokucophelela ezithola ukwesekwa kokuphila kwe-extracorporeal ukuze zibambe iqhaza ezinqubweni zokuvuma ukwaziswa kanye nokuvuselelwa ngokomzimba, futhi zithole imiphumela ngemva kokufakelwa okufanayo naleyo yeziguli ezazingadingi ukwesekwa kokuphila kwe-extracorporeal ngaphambi kokufakelwa.
Isifo se-systemic esihambisanayo phambilini besithathwa njengokuphikisa ngokuphelele, kodwa umthelela waso emiphumeleni yangemva kokufakelwa manje kufanele uhlolwe ngokuqondile. Njengoba kunikezwe ukuthi ukuzivikela komzimba okuhlobene nokufakelwa kwandisa amathuba okubuya komdlavuza, imihlahlandlela yangaphambili mayelana nezifo ezivele zikhona zagcizelela isidingo sokuthi iziguli zingabi nawo umdlavuza iminyaka emihlanu ngaphambi kokufakwa ohlwini lokulinda ukufakelwa. Kodwa-ke, njengoba izindlela zokwelapha umdlavuza zisebenza kangcono, manje sekuyanconywa ukuthi kuhlolwe ukuthi kungenzeka yini ukuthi umdlavuza uphindaphindeke ngokwesisekelo esithile sesiguli. Isifo se-systemic autoimmune ngokuvamile besibhekwa njengesiphikiswa, umbono oyinkinga ngoba isifo samaphaphu esithuthukile sivame ukukhawulela iminyaka yokuphila yeziguli ezinjalo. Iziqondiso ezintsha zincoma ukuthi ukufakelwa kwamaphaphu kufanele kwandulelwe ukuhlolwa kwezifo ezihlosiwe kanye nokwelashwa ukuze kuncishiswe ukubonakaliswa kwezifo okungase kube nomthelela omubi emiphumeleni, njengezinkinga ze-esophageal ezihlobene ne-scleroderma.
Ukujikeleza amasosha omzimba ngokumelene nezigaba ezithile ze-HLA kungenza abanye abangaba abamukeli bangezwani nezitho ezithile zokunikela, okuholela ekulindeni okude, ukuncipha kwamathuba okufakelwa, ukwaliwa kwesitho esinamandla, kanye nengozi ephakeme ye-CLAD. Kodwa-ke, okunye ukufakelwa phakathi kwamasosha omzimba owamukela ikhandidethi nezinhlobo zabanikelayo kuye kwazuza imiphumela efanayo ngemithi yangaphambi kokuhlinzwa yokungabi nazwelo, okuhlanganisa ukushintshaniswa kwe-plasma, i-immunoglobulin efakwa emthanjeni, kanye nokwelashwa kwe-anti-B cell.
Ukukhethwa kanye nokusetshenziswa kwamaphaphu anikelayo
Ukunikela ngezitho zomzimba kuyisenzo sokuzinikela. Ukuthola imvume yabanikeli kanye nokuhlonipha ukuzimela kwabo yizici zokuziphatha ezibaluleke kakhulu. Amaphaphu anikelayo angase alinyazwe ukuhlukumezeka kwesifuba, i-CPR, isifiso, i-embolism, ukulimala okuhlobene nokuphefumula noma ukutheleleka, noma ukulimala kwe-neurogenic, ngakho-ke amaphaphu amaningi abanikeli awafaneleki ukufakelwa kabusha. I-ISHLT (Inhlangano Yamazwe Ngamazwe Yenhliziyo Nokufakelwa Kwephaphu)
I-Lung Transplantation ichaza indlela yokunikela eyamukelwa ngokujwayelekile, ehlukayo ukusuka esikhungweni sokufakelwa kuya endaweni yokufakela. Eqinisweni, bambalwa kakhulu abanikelayo abahlangabezana nemibandela “ekahle” yokunikela ngamaphaphu (Umfanekiso 2). Ukwenyuka kokusetshenziswa kwamaphaphu anikelayo kuye kwafinyelelwa ngokuxegiswa kwemibandela yokunikela (okungukuthi, abanikeli abangahlangabezani nezindinganiso ezijwayelekile ezijwayelekile), ukuhlola ngokucophelela, ukunakekelwa kwabanikelayo okusebenzayo, nokuhlolwa kwe-in vitro (Umfanekiso 2). Umlando wokubhema osebenzayo ngumnikeli uyisici esiyingozi sokungasebenzi kahle kokuxhunyelelwa kumamukeli, kodwa ubungozi bokufa ngenxa yokusetshenziswa kwalezo zitho bulinganiselwe futhi kufanele kukalwe ngemiphumela yokufa yokulinda isikhathi eside iphaphu elinikelayo kumuntu ongakaze abheme. Ukusetshenziswa kwamaphaphu avela kubanikeli abadala (abangaphezu kweminyaka engama-70) abakhethwe ngokuqinile futhi abangenazo ezinye izici zobungozi bangathola imiphumela efanayo yokuphila kwabamukeli kanye nokusebenza kwamaphaphu njengaleyo evela kubanikeli abancane.
Ukunakekelwa okufanele kwabanikela ngezitho eziningi kanye nokucatshangelwa okungenzeka kube umnikelo wamaphaphu kubalulekile ukuze kuqinisekiswe ukuthi amaphaphu anikelayo anethuba eliphezulu lokufanelekela ukufakelwa. Nakuba ambalwa amaphaphu ahlinzekwayo njengamanje ahlangabezana nencazelo evamile yephaphu elifanele elinikelayo, ukuxegisa imibandela ngale kwalezi zindlela zokuhlola ezivamile kungaholela ekusetshenzisweni ngempumelelo kwezitho ngaphandle kokuphazamisa imiphumela. Izindlela ezimisiwe zokulondoloza amaphaphu zisiza ukuvikela ubuqotho besitho ngaphambi kokuba sifakwe kumamukeli. Izitho zingathuthwa ziyiswe ezindaweni zokufakelwa ngaphansi kwezimo ezihlukene, njengokulondolozwa kwe-cryostatic noma ukufakwa kwemishini ngomshini ku-hypothermia noma izinga lokushisa elivamile lomzimba. Amaphaphu abhekwa njengakufanelekele ukufakelwa kabusha ngokushesha angase aphinde ahlolwe ngendlela efanele futhi angase elashwe nge-in vitro lung perfusion (EVLP) noma agcinwe isikhathi eside ukuze kunqotshwe izithiyo zenhlangano zokufakelwa kabusha. Uhlobo lokufakelwa kwamaphaphu, inqubo, nokusekelwa ngokuhlinza konke kuncike ezidingweni zesiguli kanye nolwazi lukadokotela ohlinzayo nalokho akuthandayo. Kulabo abangase babe abamukeli bokufakelwa amaphaphu abanesifo sabo esiwohlokayo kakhulu ngenkathi belinde ukufakelwa, ukwesekwa kwempilo engaphandle komzimba kungase kubhekwe njengokwelashwa kokuguqulwa kwangaphambi kokufakelwa. Izinkinga zangaphambi kokuhlinzwa zingase zihlanganise ukopha, ukuvinjwa kwendlela yokuphefumula noma i-vascular anastomosis, nokutheleleka ngenxeba. Ukulimala kwe-phrenic noma i-vagus nerve esifubeni kungaholela kwezinye izinkinga, ezithinta ukusebenza kwe-diaphragm kanye nokukhipha isisu, ngokulandelanayo. Iphaphu elinikelayo lingase libe nokulimala ngokushesha okukhulu kwamaphaphu ngemva kokufakelwa nokuphinda kufakwe amaphaphu, okungukuthi ukungasebenzi kahle kokuxhunyelelwa. Kunengqondo ukuhlukanisa nokwelapha ubulukhuni bokungasebenzi kahle kokuxhunyelelwa, okuhlotshaniswa nengozi enkulu yokufa ngaphambi kwesikhathi. Ngenxa yokuthi okungaba khona umonakalo wamaphaphu onikelayo kwenzeka phakathi namahora okulimala kokuqala kobuchopho, ukuphathwa kwamaphaphu kufanele kufake Izilungiselelo zokungena komoya ezifanele, ukunwetshwa kabusha kwe-alveolar, i-bronchoscopy ne-aspiration and lavage (ngokwenza amasampula amasiko), ukuphathwa koketshezi lwesiguli, nokulungiswa kwendawo yesifuba. I-ABO imele iqembu legazi A, B, AB kanye no-O, i-CVP imele umfutho we-venous ophakathi, i-DCD imele umnikezeli wamaphaphu ekufeni kwenhliziyo, i-ECMO imele i-extracorporeal membrane oxygenation, i-EVLW imele amanzi e-extravascular pulmonary, i-PaO2/FiO2 imele isilinganiso somfutho we-arterial partial oxygen pressure ukuze uhogele umoya-mpilo we-PEexpirary I-PiCCO imele ukukhishwa kwenhliziyo kwe-pulse index waveform.
Kwamanye amazwe, ukusetshenziswa kwe-controlled donor lung (DCD) kukhuphuke kwafinyelela ku-30-40% ezigulini ezibulawa yinhliziyo, futhi amazinga afanayo okulahlwa kwesitho esinamandla, i-CLAD, nokusinda kuye kwafinyelelwa. Ngokwesiko, izitho ezivela kubanikeli abanegciwane elithelelanayo kufanele zigwenywe ukuze zidluliselwe kwabamukeli abangenalo igciwane; Nokho, eminyakeni yamuva nje, izidakamizwa ezilwa namagciwane ezisebenza ngokuqondile ngokumelene negciwane lesifo sokusha kwesibindi kohlobo C (HCV) zenze amaphaphu anikelayo ane-HCV akwazi ukufakelwa ngokuphepha abemukeli abangenayo i-HCV. Ngokufanayo, amaphaphu anikela ngegciwane lesandulela ngculazi (human immunodeficiency virus) (HIV) angadluliselwa kwabamukeli abane-HIV, futhi amaphaphu anikela ngegciwane le-hepatitis B (HBV) angatshalwa kabusha kube abamukeli abagonyelwe i-HBV kanye nalabo abangavikelekile. Kube nemibiko yokufakelwa kwamaphaphu okuvela kubanikeli abatheleleke nge-SARS-CoV-2 abasebenzayo noma bangaphambili. Sidinga ubufakazi obengeziwe ukuze sinqume ukuphepha kokuthelela amaphaphu abanikeli ngamagciwane athathelwanayo ukuze kufakwe omunye umuntu.
Ngenxa yobunkimbinkimbi bokuthola izitho eziningi, kuyinselele ukuhlola ikhwalithi yamaphaphu anikelayo. Ukusebenzisa i-in vitro lung perfusion system ukuze kuhlolwe kuvumela ukuhlolwa okuningiliziwe komsebenzi wamaphaphu anikelayo kanye namandla okuwulungisa ngaphambi kokuwusebenzisa (Umfanekiso 2). Njengoba iphaphu elinikelayo lisengozini enkulu yokulimala, uhlelo lwe-in vitro lung perfusion luhlinzeka ngenkundla yokulawulwa kwemithi ethile yebhayoloji ukuze kulungiswe iphaphu elimele elimele (Umfanekiso 2). Ukuhlola okubili okungahleliwe kubonise ukuthi izinga lokushisa lomzimba elivamile le-in vitro ukugcwala kwamaphaphu anikelayo ahlangabezana nemibandela evamile kuphephile nokuthi ithimba lokufakelwa kabusha linganweba isikhathi sokulondoloza ngale ndlela. Ukugcina amaphaphu anikelayo ku-hypothermia ephakeme (6 kuya ku-10 ° C) kune-0 kuya ku-4 ° C eqhweni kuye kwabikwa ukuthi kuthuthukisa impilo ye-mitochondrial, ukunciphisa umonakalo, nokuthuthukisa ukusebenza kwamaphaphu. Ngokufakelwa kolunye usuku olukhethiwe, ukulondolozwa kwasebusuku isikhathi eside kubikwe ukuze kuzuzwe imiphumela emihle yangemva kokufakelwa. Isivivinyo esikhulu sokuphepha esingesona esiphansi esiqhathaniswa nokulondolozwa ku-10°C ne-cryopreservation evamile siyaqhubeka (inombolo yokubhalisa i-NCT05898776 at ClinicalTrials.gov). Abantu baya ngokuya begqugquzela ukululama kwesitho ngesikhathi ngezikhungo zokunakekela izitho eziningi kanye nokwenza ngcono ukusebenza kwezitho zomzimba ngokusebenzisa izikhungo zokulungisa izitho zomzimba, ukuze izitho zekhwalithi engcono zisetshenziselwe ukufakelwa. Umthelela walezi zinguquko ohlelweni lwe-ecosystem yokutshala kabusha usahlolwa.
Ukuze kulondolozwe izitho ze-DCD ezilawulekayo, ukufakwa kwasendaweni kokushisa komzimba okujwayelekile endaweni nge-extracorporeal membrane oxygenation (ECMO) kungasetshenziswa ukuhlola ukusebenza kwezitho zesisu nokusekela ukutholwa okuqondile nokugcinwa kwezitho zesifuba, okuhlanganisa namaphaphu. Okuhlangenwe nakho ngokufakelwa kwamaphaphu ngemva kokujova endaweni yokushisa komzimba okuvamile esifubeni nasesiswini kunomkhawulo futhi imiphumela iyaxutshwa. Kunokukhathazeka ngokuthi le nqubo ingase ibangele umonakalo kubanikeli abashonile futhi yephule izimiso zokuziphatha eziyisisekelo zokuvuna izitho zomzimba; Ngakho-ke, i-perfusion yendawo ekushiseni komzimba okuvamile akukakavunyelwa emazweni amaningi.
Umdlavuza
Izehlakalo zomdlavuza kubantu ngemuva kokufakelwa kwamaphaphu ziphezulu kunesabanye abantu, futhi lesi sifo sivame ukuba sibi, sibalele ku-17% wokufa. Umdlavuza wamaphaphu kanye nesifo se-post-transplant lymphoproliferative (PTLD) yizona zimbangela ezivame kakhulu zokufa okuhlobene nomdlavuza. Ukuvinjelwa kokuzivikela komzimba isikhathi eside, imiphumela yokubhema kwangaphambilini, noma ingozi yesifo samaphaphu esingaphansi konke kuholela engcupheni yokuba nomdlavuza wamaphaphu ephashini elilodwa lomamukeli wamaphaphu, kodwa ezimweni ezingavamile, umdlavuza wamaphaphu odluliselwa ngomnikeli ungase ube khona emaphashini atshalwe kabusha. Umdlavuza wesikhumba ongeyona i-melanoma umdlavuza ovame kakhulu phakathi kwabamukeli bokufakelwa, ngakho ukuqapha umdlavuza wesikhumba okuvamile kubalulekile. I-B-cell PTLD ebangelwa igciwane le-Epstein-Barr iyimbangela ebalulekile yezifo nokufa. Nakuba i-PTLD ingaxazulula nge-immunosuppression encane, ukwelashwa okuqondiswe kwe-B-cell nge-rituximab, i-systemic chemotherapy, noma kokubili kuyadingeka.
Ukusinda kanye nemiphumela yesikhathi eside
Ukusinda ngemva kokufakelwa kwamaphaphu kuhlala kulinganiselwe uma kuqhathaniswa nokunye ukufakelwa kwezitho zomzimba, okunesilinganiso esimaphakathi seminyaka engu-6.7, futhi intuthuko encane yenziwe emiphumeleni yesikhathi eside yesiguli eminyakeni engamashumi amathathu. Kodwa-ke, iziguli eziningi zithole ukuthuthukiswa okuphawulekayo kwekhwalithi yokuphila, isimo somzimba, kanye neminye imiphumela ebikwa ngesiguli; Ukuze kwenziwe ukuhlolwa okubanzi kwemiphumela yokwelapha yokufakelwa kwamaphaphu, kuyadingeka ukunaka kakhulu imiphumela ebikwe yilezi ziguli. Isidingo esibalulekile somtholampilo esingakafinyelelwanga ukubhekana nokufa komamukeli ngenxa yezinkinga ezibulalayo zokwehluleka ukuxhunyelelwa okubambezelekile noma ukucindezelwa kwamasosha omzimba isikhathi eside. Kwabamukeli bokufakelwa kwamaphaphu, kufanele kunikezwe ukunakekelwa okusebenzayo kwesikhathi eside, okudinga ukusebenzisana ukuze kuvikelwe impilo yonke yomamukeli ngokuqapha nokugcina umsebenzi wokuxhunyelelwa ngakolunye uhlangothi, kuncishiswe imiphumela emibi yokuvinjelwa kokuzivikela komzimba kanye nokusekela impilo engokomzimba nengqondo yomamukeli ngakolunye uhlangothi (Umfanekiso 1).
Isiqondiso esizayo
Ukufakelwa kabusha kwamaphaphu kuwukwelashwa osekuhambe ibanga elide ngesikhathi esifushane, kodwa okusazofinyelela amandla ako aphelele. Ukushoda kwamaphaphu afanele anikelayo kuseyinselele enkulu, futhi zisathuthukiswa izindlela ezintsha zokuhlola nokunakekela abanikelayo, ukwelapha nokulungisa amaphaphu abanikeli, kanye nokuthuthukisa ukulondolozwa kwabanikeli. Kudingeka ukuthuthukisa izinqubomgomo zokwabiwa kwezitho ngokuthuthukisa ukufana phakathi kwabanikeli nabamukeli ukuze kuthuthukiswe isamba sezinzuzo. Kukhona isithakazelo esikhulayo ekuhlonzeni ukwenqatshwa noma ukutheleleka ngokuxilonga amangqamuzana, ikakhulukazi nge-DNA yamahhala ephuma kumnikeli, noma ekuqondiseni ukunciphisa ukucindezelwa kwamasosha omzimba; Kodwa-ke, ukusetshenziswa kwalokhu kuhlola njengesengezo sezindlela zamanje zokuqapha ukuxhunyelelwa komtholampilo kusazonqunywa.
Umkhakha wokufakelwa kwamaphaphu uthuthuke ngokwakhiwa kwama-consortiums (isb, inombolo yokubhalisa ye-ClinicalTrials.gov NCT04787822; https://lungtransplantconsortium.org) indlela yokusebenzisana, izosiza ekuvimbeleni nasekwelapheni ukungasebenzi kahle kokuxhunyelelwa okuyisisekelo, ukubikezela kwe-CLAD, ukuxilongwa kusenesikhathi kanye nenqubekelaphambili yangaphakathi (i-endofting syndrome, i-endofting eyisisekelo) ukungasebenzi, ukwenqatshwa kwe-antibody-mediated, izindlela ze-ALAD ne-CLAD. Ukunciphisa imiphumela engemihle kanye nokunciphisa ubungozi be-ALAD ne-CLAD ngokwelashwa komuntu siqu kwe-immunosuppressive, kanye nokuchaza imiphumela egxile esigulini nokuyihlanganisa nezinyathelo zomphumela, kuzoba ukhiye wokuthuthukisa impumelelo yesikhathi eside yokufakelwa kwamaphaphu.
Isikhathi sokuthumela: Nov-23-2024