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2007, Número 4

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Gac Med Mex 2007; 143 (4)


Estado actual del trasplante pulmonar

García-Covarrubias L, Salerno TA, Panos AL, Pham SM

Idioma: Español
Referencias bibliográficas: 261
Paginas: 323-332
Archivo PDF: 121.82 Kb.


RESUMEN

Actualmente el trasplante pulmonar es considerado como tratamiento definitivo para algunas enfermedades pulmonares avanzadas. Los primeros trasplantes pulmonares experimentales en animales fueron realizados en los años 1940’s por el soviético Vladimir P. Demikhov. Sin embargo, pasaron aproximadamente dos décadas antes de que se realizara el primer trasplante pulmonar en humanos por el doctor James Hardy. Desafortunadamente los inicios clínicos del trasplante pulmonar no fueron muy exitosos debido a complicaciones quirúrgicas y efectos secundarios de los fármacos inmunosupresores. Gracias al mejoramiento de la técnica quirúrgica y al desarrollo de fármacos inmunosupresores más efectivos y menos tóxicos, la morbimortalidad ha disminuido significativamente. La selección y el cuidado del donador antes de la procuración de los órganos juegan un papel primordial en los resultados en el receptor. Debido a la escasez de donadores, algunas instituciones están utilizando criterios de selección más liberales con resultados satisfactorios. El manejo del paciente con trasplante pulmonar o del bloque cardiopulmonar requiere de un enfoque multidisciplinario que incluye al cirujano de trasplantes cardiotorácicos, al neumólogo, al anestesiólogo y al intensivista entre otros. En este artículo revisamos aspectos históricos y avances recientes en el manejo de estos pacientes incluyendo indicaciones y contraindicaciones, evaluación y cuidado del donador y del receptor, técnica quirúrgica y manejo peri- y posoperatorio.


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  144. Santillán-Doherty P, Odor-Morales A, Jasso R, et al. Urinary thromboxane B2 as an indicator of acute rejection in lung allotransplantation. Transplantation 1988;45:852-856.

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