Akciğer Transplantasyonunda Hasta Seçimi ve Pre-Operatif Hazırlık
Özet
Akciğer nakli, medikal tedaviye yanıt vermeyen son evre akciğer hastalıklarında hayat kalitesini ve sağ kalımı artıran radikal bir cerrahi seçenektir. Alıcı adayı seçiminde, iki yıl içinde ölüm riskinin %50'den fazla olması ve nakil sonrası 90 gün hayatta kalma olasılığının %80’in üzerinde bulunması genel kriterler olarak kabul edilir. Son 5 yılda malignite öyküsü, majör organ disfonksiyonları ve BMI'ın 35 ve üzerinde olması gibi durumlar mutlak kontrendikasyon teşkil ederken; 65 yaş üstü olmak ve şiddetli malnütrisyon göreceli kontrendikasyonlar arasında yer alır. Nakil endikasyonları obstrüktif, pulmoner vasküler, enfeksiyöz ve restriktif akciğer hastalıkları olmak üzere dört ana grupta toplanır. Zamanlamanın hayati önem taşıdığı KOAH hastalarında sevk ve listeleme için BODE indeksi kullanılırken, kötü prognoza sahip interstisyel akciğer hastalarının merkeze erken yönlendirilmesi gerekir. Kistik fibrozis ve bronşektazide FEV1 değerleri ile sık enfeksiyonlar belirleyicidir. Bekleme listesindeki hastalar 3-6 aylık aralıklarla rutin tetkikler, aşılamalar ve beslenme desteği yönünden yakından izlenir. Ayrıca adayların egzersiz kapasitesini korumak için pulmoner rehabilitasyon uygulanırken, süreçle ilişkili yoğun stresi yönetmek amacıyla psikososyal destek sağlanır.
Lung transplantation is a radical surgical treatment option that significantly improves quality of life and survival in end-stage lung diseases unresponsive to medical therapy. General selection criteria for candidates include a predicted two-year mortality risk exceeding 50% and a post-transplant 90-day survival probability greater than 80%. Absolute contraindications involve a history of malignancy within the past 5 years, major extrapulmonary organ dysfunction, and a BMI of 35 or above, whereas patients over 65 years old and severe malnutrition are categorized as relative contraindications. Indications are classified into four groups: obstructive, pulmonary vascular, infectious, and restrictive lung diseases. Timing is critical; the BODE index guides referral and listing in COPD patients, while interstitial lung disease patients require early referral due to poor prognosis. FEV1 values and frequent infections are decisive indicators in cystic fibrosis and bronchiectasis. Candidates on the waiting list undergo clinical monitoring every 3 to 6 months including routine tests, immunizations, and nutritional interventions. Furthermore, pulmonary rehabilitation is vital to preserve functional capacity, and comprehensive psychosocial support is provided to manage the intense psychological stress associated with the transplant process.
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