12．肺移植の周術期管理の重要ポイント

Perioperative Management in Lung Transplantation

肺移植は終末期呼吸器疾患に対する治療として確立されているが，日本ではドナー不足が依然として深刻な問題である．日本国内の肺移植実施施設は10施設と限られている．しかしながら，5類型と呼ばれる脳死下臓器提供が可能な施設は全国にあり，読者諸兄の施設で脳死下臓器提供が行われることは十分に考えられる．適切な脳死ドナー管理は安全な肺移植実施の第一歩であり，肺移植の周術期管理は提供病院から始まっているともいえる．

Lung transplantation is an established therapy for end-stage lung disease. However, donor shortage remains as a serious issue in Japan. Appropriate brain-dead donor management is the first step toward safe lung transplantation, and the perioperative management begins at the donor hospital. This article overviews the key points of perioperative management in lung transplantation, starting from the donor, the graft, followed by the recipient. Lung transplantation is not just about implanting lungs；it is also about “conditioning” the lungs to be fully functioned after transplantation. In addition to respiratory management, circulatory management, immunosuppressive therapy, and antimicrobial chemotherapy, physiotherapy and nutritional therapy to support them are all indispensable. In other words, it is a treatment including all aspects of surgical managements, which is why it is fascinating.