Transplantacija pluća

master's thesis

• Title (english): Lung transplantation
• Author: Tomislav Dujmović
• Mentor: Miroslav Samaržija (mentor)
• Committee member: Marko Jakopović (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Miroslav Samaržija (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Transplantacija pluća danas je prihvaćen način liječenja bolesnika s uznapredovalim
plućnim bolestima nemaligne etiologije čija se oštećena plućna funkcija ne može poboljšati
niti stabilizirati svim ostalim raspoloživim konzervativnim ili kirurškim načinima liječenja.
Procjena kandidata i pravovremeno upućivanje na transplantaciju te stavljanje na listu čekanja
osobito su važni. Predtransplantacijska obrada je zadatak multidisciplinarnog tima koji
podrazumijeva specijaliste pulmologe, torakalne kirurge, infektologe, medicinske sestre i
tehničare, nutricioniste, fizioterapeute, psihologe i socijalne radnike.
Indikacije za transplantaciju s vremenom se proširuju, a apsolutnih kontraindikacija je sve
manje. Posebnu problematiku predstavlja i izbor prikladnog donora kao i njegovo adekvatno
održavanje do eksplantacije organa čemu uvelike pridonosi razvoj sve boljih sustava alokacije
organa. Nekoliko je mogućih kirurških postupaka transplantacije pluća: SLT, BLT, HLT i
presađivanje plućnog režnja odnosno režnjeva živog darivatelja. Izbor kirurškog postupka
ovisi o primarnoj dijagnozi primatelja i preferencijama transplantacijskog centra.
Nakon same transplantacije, za konačan ishod ključna je što efikasnija postoperativna
intenzivna skrb kao i imunosupresivna terapija.
Transplantacija pluća je zamjena ozbiljne plućne bolesti za stanje kronične imunosupresije i
moguće doživotne komplikacije. Osim akutnog staničnog odbacivanja i kroničnog
odbacivanja čija je glavna klinička manifestacija BOS, preživljenje nakon transplantacije i
dalje ograničavaju bakterijske, virusne ili gljivične infekcije.
Transplantacija pluća ne izvodi se u Republici Hrvatskoj, ali je bolesnicima omogućena
transplantacija u Sveučilišnoj bolnici AKH Beč na temelju suradnje s Klinikom za plućne
bolesti Jordanovac.

Abstract (english)

Lung transplantation is nowadays an accepted therapeutic modality for patients with advanced
lung disease of nonmalignant etiology whose altered lung function can't be improved nor
stabilized by any other conservative treatment or surgery available. Candidate evaluation, ontime
referral and listing are of great importance for the final outcomes. Lung transplant
candidates should be evaluated by a multidisciplinary team including pulmonologists, thoracic
surgeons, infectious disease specialists, nurses, nutritionists, physiotherapists, psychologists,
and social workers.
Indications for lung transplantation are broadening while the number of absolute
contraindications is decreasing over time. Donor management and suitable donor organ
selection are becoming much easier task with the improvement of the new and more effective
allocation systems. Current lung transplant procedural options include SLT, BLT, HLT and
living donor lobar lung transplantation. The choice of procedure is based on the primary
diagnosis and transplant center preferences. The intensive postoperative care of the lung
transplant recipient and effective immunosuppressive regimens remain a key component of all
succesful transplants.
Lung transplantation substitutes life-threatening lung disease for life-long immunosuppression
and various complications. In addition to acute cellular rejection and chronic rejection which
presents as BOS, the major impediments to long-term graft and patient survival are bacterial,
viral and fungal infections.
Lung transplantation is not performed in the Republic of Croatia, but patients are enrolled in
the lung transplantation programme based on collaboration between University Hospital AKH
Wien and Department for Respiratory Diseases Jordanovac, UHC Zagreb.

• Keywords: transplantacija pluća; odabir kandidata; indikacije; komplikacije; ishodi
• Keywords (english): lung transplantation; candidate selection; indications; complications; outcomes
• Language: croatian
• URN:NBN: urn:nbn:hr:105:333028
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-29 07:17:05