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Uqhaqho-fakelo lwemiphunga lunyango olwamkelweyo lwesifo semiphunga esiphezulu. Kwiminyaka embalwa edlulileyo, ukutshintshwa kwemiphunga kuye kwenza inkqubela phambili ephawulekayo ekuhlolweni nasekuvavanyeni abamkeli bokutshintshwa, ukhetho, ukugcinwa kunye nokwabiwa kwemiphunga yomxhasi, ubuchule botyando, ulawulo lwasemva kokuhlinzwa, ulawulo lwengxaki, kunye nokunciphisa umzimba.

Ngaphezu kweminyaka engama-60, uqhaqho-fakelo lwemiphunga luye lwavela kunyango lovavanyo lwaya kunyango oluqhelekileyo olwamkelweyo lwesifo semiphunga esibeka ubomi esichengeni. Ngaphandle kweengxaki eziqhelekileyo ezifana nokungasebenzi kakuhle kwe-graft, ukutshintshwa okungapheliyo kwe-lung dysfunction (CLAD), ukwanda komngcipheko wosulelo olungenelelayo, umhlaza, kunye neengxaki zempilo ezingapheliyo ezinxulumene nokugonywa komzimba, kukho isithembiso sokuphucula ukusinda kwesigulana kunye nomgangatho wobomi ngokukhethwa kommkeli ofanelekileyo. Ngelixa uqhaqho-fakelo lwemiphunga lusiya luxhaphaka kwihlabathi jikelele, inani lemisebenzi ayikahambelani nemfuno ekhulayo. Olu phononongo lujolise kwimeko yangoku kunye nenkqubela phambili yamva nje yokufakelwa kwemiphunga, kunye namathuba exesha elizayo okuphunyezwa ngempumelelo kolu nyango lunzima kodwa olunokutshintsha ubomi.

Ukuphononongwa kunye nokukhethwa kwabanokuba ngabamkeli
Ngenxa yokuba imiphunga efanelekileyo yomnikeli inqabile, amaziko ofakelo lomzimba ayafuneka ngokwemigaqo yokwabelwa ngamalungu omnikeli kwabo banokuba ngabamkeli abanokuthi bafumane inzuzo eshiyekileyo kuqhaqho-fakelo. Inkcazo yemveli yabaxhamli abanjalo kukuba banoqikelelo olungaphezulu kwe-50% yomngcipheko wokufa ngenxa yesifo semiphunga phakathi kweminyaka emi-2 kunye nethuba elingaphezu kwama-80% lokusinda kwiminyaka emi-5 emva kokutshintshwa, becinga ukuba imiphunga eyofakelweyo isebenza ngokupheleleyo. Ezona zibonakaliso zixhaphakileyo zotyando lwemiphunga yipulmonary fibrosis, isifo semiphunga esinganyangekiyo, isifo sepulmonary vascular disease, kunye necystic fibrosis. Izigulane zibhekiswa ngokusekelwe ekunciphiseni ukusebenza kwemiphunga, ukunciphisa umsebenzi womzimba, kunye nokuqhubela phambili kwesifo naphezu kokusetyenziswa kakhulu kweyeza kunye nonyango lotyando; Ezinye iikhrayitheriya ezijongene nesifo nazo ziyaqwalaselwa. Imingeni ye-prognostic ixhasa izicwangciso zokudluliselwa kwangaphambili ezivumela iingcebiso ezingcono zomngcipheko-benefit ukuphucula ukuthathwa kwezigqibo ekwabelwana ngazo kunye nethuba lokutshintsha imiqobo enokubakho kwiziphumo eziyimpumelelo zofakelo. Iqela lee-multidisciplinary liya kuvavanya imfuno yofakelo lwemiphunga kunye nomngcipheko wesigulane weengxaki zasemva kokutshintshwa ngenxa yokusetyenziswa kwe-immunosuppressant, njengengozi yosulelo olunokubeka ubomi esichengeni. Ukuvavanyelwa ukungasebenzi kakuhle kwelungu lemiphunga engaphaya kwemiphunga, ukomelela komzimba, impilo yengqondo, inkqubo yokugonywa komzimba kunye nomhlaza kubalulekile. Uvavanyo oluthile lwe-coronary and cerebral arteries, umsebenzi wezintso, impilo yethambo, umsebenzi we-esophageal, amandla engqondo kunye nenkxaso yentlalo kubalulekile, ngelixa kuthathwa ukunakekelwa ukuze kugcinwe izinto ezibonakalayo ukuze kugwenywe ukungalingani ekunqumeni ukufaneleka kokutshintshwa.

Imiba yomngcipheko emininzi iyingozi ngakumbi kunemiba yomngcipheko omnye. Izithintelo zesiNtu zokufakelwa utyando ziquka ubudala, ukutyeba, imbali yomhlaza, ukugula okubalulekileyo, kunye nesifo senkqubo ehambelanayo, kodwa ezi zinto zisandula ukucelwa umngeni. Ubudala babamkeli bukhula ngokuthe ngcembe, kwaye ngo-2021, i-34% yabamkeli e-United States baya kuba badala kuneminyaka engama-65, nto leyo ebonisa ukwanda kogxininiso lobudala bebhayoloji ngaphezulu kweminyaka yokulandelelana kweziganeko. Ngoku, ukongeza kumgama wokuhamba wemizuzu emithandathu, kudla ngokubakho uvavanyo olusesikweni ngakumbi lobuthathaka, kugxilwe kugcino lomzimba kunye neempendulo ezilindelekileyo kubaxinzelelo. Ubuthathaka bunxulunyaniswa neziphumo ezibi emva kokutshintshwa kwemiphunga, kwaye ubuthathaka budla ngokunxulunyaniswa nokubunjwa komzimba. Iindlela zokubala ukutyeba kakhulu kunye nokwakheka komzimba ziyaqhubeka nokuvela, kugxininise kancinci kwi-BMI nangaphezulu kumxholo wamafutha kunye nobunzima bemisipha. Izixhobo ezithembisa ukulinganisa i-faltering, i-oligomyosis, kunye nokuqina ziphuhliswa ukuze ziqikelele ngcono ukukwazi ukubuyisela emva kokutshintshwa kwemiphunga. Ngokulungiswa kwangaphambili kwemiphunga, kunokwenzeka ukuguqula ukubunjwa komzimba kunye nokukhubazeka, ngaloo ndlela kuphuculwe iziphumo.

Kwimeko yokugula okumandundu, ukufumanisa ubungakanani bobuthathaka kunye nokukwazi ukuchacha kulucelomngeni ngakumbi. Utshintsho kwizigulana ezifumana umoya wokungena ngoomatshini bezinqabile ngaphambili, kodwa ngoku ziya zixhaphaka. Ukongeza, ukusetyenziswa kwenkxaso yobomi be-extracorporeal njengonyango lwenguqu yangaphambi kokutshintshwa kuye kwanda kwiminyaka yakutshanje. Ukuqhubela phambili kwethekhnoloji kunye nokufikelela kwi-vascular kwenze ukuba kube lula ukuba izigulane eziqaphelayo, ezikhethwe ngokucokisekileyo zifumana inkxaso yokuphila ngaphandle kwe-extracorporeal ukuba zithathe inxaxheba kwiinkqubo zemvume enolwazi kunye nokuvuselelwa komzimba, kunye nokufezekisa iziphumo emva kokutshintshwa okufanayo kunye nezigulane ezingazange zifune inkxaso yokuphila ngaphandle kwe-extracorporeal ngaphambi kokutshintshwa.
Isifo senkqubo esihambelanayo ngaphambili sasithathwa njengento echasene ngokupheleleyo, kodwa impembelelo yaso kwiziphumo zasemva kokutshintshwa kufuneka ngoku ihlolwe ngokuthe ngqo. Ngenxa yokuba ukunyanzeliswa kwe-immunosuppression okunxulumene nokufakelwa komhlaza kwandisa ukubakho kokuphinda umhlaza, izikhokelo zangaphambili malunga nonyango olukhoyo lwagxininisa imfuno yokuba abaguli bangabinawo umhlaza iminyaka emihlanu ngaphambi kokubekwa kuluhlu lokulinda lokutshintshwa. Nangona kunjalo, njengoko unyango lomhlaza lusebenza ngakumbi, kuyacetyiswa ngoku ukuba kuhlolwe ukuba nokwenzeka kokuphindwa komhlaza ngokwesiseko esikhethekileyo. Isifo se-systemic autoimmune ngokwesiko sithathwa njengechaswa, umbono oyingxaki kuba isifo semiphunga esiphucukileyo sithande ukunciphisa ixesha lokuphila kwezigulana ezinjalo. Izikhokelo ezitsha zincoma ukuba ukutshintshwa kwemiphunga kufuneka kuqhutywe phambili kuvavanyo olujoliswe ngakumbi lwesifo kunye nonyango lokunciphisa ukubonakaliswa kwezifo ezinokuthi zichaphazele kakubi iziphumo, njengeengxaki ze-esophageal ezinxulumene ne-scleroderma.
Ukujikeleza izilwa-buhlungu ngokuchasene neendidi ezithile ze-HLA kunokwenza ukuba abanye abantu abanokuba ngabamkeli badibane namalungu athile anikezelayo, okukhokelela kwixesha elide lokulinda, ukunciphisa amathuba okufakelwa, ukwaliwa kwamalungu abukhali, kunye nomngcipheko ophakamileyo we-CLAD. Nangona kunjalo, okunye ukutshintshwa phakathi kwe-antibodies yabamkeli kunye neentlobo zabanikeli baye bafumana iziphumo ezifanayo kunye neerejimeni ze-desensitization yangaphambi kokusebenza, kubandakanywa utshintshiselwano lwe-plasma, i-immunoglobulin ye-intravenous, kunye ne-anti-B cell therapy.

Ukukhethwa kunye nokusetyenziswa kwemiphunga yomxhasi
Umnikelo wamalungu sisenzo sobubele. Ukufumana imvume yabanikeli kunye nokuhlonipha ukuzimela kwabo zezona zinto zibalulekileyo zokuziphatha. Imiphunga yomnikeli inokonakala ngenxa yokwenzakala kwesifuba, iCPR, ukulangazelela, i-embolism, ukwenzakala okunxulumene ne-ventilator okanye usulelo, okanye ukwenzakala kwe-neurogenic, ngoko ke imiphunga emininzi yabanikeli ayifanelekanga ukutshintshwa. ISHLT (uMbutho weHlabathi weNtliziyo kunye noTshintsho lwemiphunga)
UTshintsho lweLung luchaza indlela yomnikeli eyamkelekileyo jikelele, eyahlukayo ukusuka kwiziko lofakelo ukuya kwiziko lofakelo. Enyanisweni, bambalwa kakhulu abaxhasi abahlangabezana nemilinganiselo “efanelekileyo” yokunikela ngemiphunga (Umfanekiso 2). Ukusetyenziswa okwandisiweyo kwemiphunga yabanikezeli kuye kwaphunyezwa ngokunyenyiselwa kwemigaqo yabanikeli (oko kukuthi, abanikeli abangafikeleliyo kwimigangatho eqhelekileyo), uphononongo ngononophelo, ukhathalelo olusebenzayo lomnikezeli, kunye novavanyo lwe-invitro (Umfanekiso 2). Imbali yokutshaya okusebenzayo ngumnikeli ngumngcipheko wokungasebenzi kakuhle kwe-graft kumamkeli, kodwa umngcipheko wokufa ngenxa yokusetyenziswa kwaloo malungu unqunyelwe kwaye kufuneka ulinganiswe ngokuchasene neziphumo zokufa zokulinda ixesha elide lomphunga womnikezeli kumntu ongazange atshaye. Ukusetyenziswa kwemiphunga esuka kubantu abadala (abangaphezulu kweminyaka engama-70) abanikezeli abakhethwe ngokungqongqo kwaye abangenayo eminye imiba yomngcipheko banokufikelela kwiziphumo ezifanayo zobomi bomamkeli kunye nokusebenza kwemiphunga njengaleyo evela kubaxhasi abancinci.

Ukhathalelo olululo kubaxhasi bamalungu amaninzi kunye nokuqwalaselwa kweminikelo yemiphunga enokwenzeka kubalulekile ukuqinisekisa ukuba imiphunga yomxhasi inethuba eliphezulu lokuba ikulungele ukutshintshwa. Ngelixa imiphunga embalwa ebonelelweyo ngoku ihlangabezana nenkcazelo yemveli yomphunga ofanelekileyo onikelayo, ukunyenyisa imilinganiselo engaphaya kwezi ndlela zesithethe kunokukhokelela ekusetyenzisweni ngempumelelo kwamalungu ngaphandle kokubeka esichengeni iziphumo. Iindlela ezisemgangathweni zokugcinwa kwemiphunga zinceda ukukhusela ingqibelelo yelungu ngaphambi kokuba lifakwe kumamkeli. Amalungu angathuthelwa kwiindawo zokutshintshwa phantsi kweemeko ezahlukeneyo, ezifana nokugcinwa kwe-cryostatic okanye i-perfusion yomatshini kwi-hypothermia okanye ukushisa komzimba okuqhelekileyo. Imiphunga engagqalwa njengokufaneleyo utyando olukhawulezileyo inokuvavanywa ngokubhekele phaya kwaye inokunyangwa nge-in vitro lung perfusion (EVLP) okanye igcinwe ixesha elide ukoyisa imiqobo yombutho kuqhaqho-fakelo. Uhlobo loqhaqho-fakelo lwemiphunga, inkqubo nenkxaso yotyando zonke zixhomekeke kwiimfuno zesigulana kunye namava ogqirha wotyando nezinto azikhethayo. Kubantu abanokubakho abafumana uqhaqho-fakelo lwemiphunga abanesifo sabo esiba mandundu kakhulu ngelixa belindele uqhaqho-fakelo, inkxaso yobomi obungaphandle komzimba inokuthi ithathwe njengonyango lotshintsho lwangaphambili. Iingxaki zakwangoko emva kokuhlinzwa zingabandakanya ukopha, ukuvaleka kwendlela yomoya okanye i-vascular anastomosis, kunye nokusuleleka kwesilonda. Umonakalo kwi-phrenic okanye i-vagus nerve esifubeni kunokukhokelela kwezinye iingxaki, ezichaphazela umsebenzi we-diaphragm kunye nokukhutshwa kwesisu, ngokulandelanayo. Umphunga onikelayo unokuba nomonzakalo wemiphunga kwangethuba emva kokufakwa kunye nokufakelwa ngokutsha, oko kukuthi, ukungasebenzi kakuhle kokuxhunyelelwa. Kunentsingiselo ukucalula kunye nokunyanga ubungqongqo bokungasebenzi kakuhle kwe-graft, nto leyo eyayanyaniswa nomngcipheko omkhulu wokusweleka kwangoko. Ngenxa yokuba umonakalo onokuthi ube ngumnikeli wemiphunga wenzeke kwisithuba seeyure zokwenzakala kokuqala kobuchopho, ulawulo lwemiphunga kufuneka luquke iiSetingi zokungena komoya ezifanelekileyo, ukwandiswa kwakhona kwe-alveolar, ibronchoscopy kunye nokulangazelela kunye nokuhlamba (ukwenzela iisampulu zeenkcubeko), ulawulo lolwelo lwesigulana, kunye nohlengahlengiso lwendawo yesifuba. I-ABO imele iqela legazi A, B, AB kunye ne-O, i-CVP imele uxinzelelo lwe-venous ephakathi, i-DCD imele i-lung donor ephuma kwi-cardiac death, i-ECMO imele i-extracorporeal membrane oxygenation, i-EVLW imele i-extravascular pulmonary water, i-PaO2 / i-FiO2 imele umlinganiselo woxinzelelo lwe-arterial partial oksijini ukuze uphefumle umoya we-oxygen ophelile, i-PEX ye-oxygen yokuphefumlelwa I-PiCCO imele imveliso yentliziyo ye-pulse index waveform.
Kwamanye amazwe, ukusetyenziswa kwemiphunga yomxhasi (DCD) elawulwayo kuye kwaphakama ukuya kwi-30-40% kwizigulane ezinesifo senhliziyo, kwaye amazinga afanayo okulahlwa kwelungu elibukhali, i-CLAD, kunye nokusinda kuye kwafunyanwa. Ngokwesiko, amalungu avela kubanikeli abosulelwe yintsholongwane eyosulelayo kufuneka aphetshwe ukuze atshintshelwe kubantu abangosulelwanga; Noko ke, kwiminyaka yakutshanje, amachiza okuthomalalisa iintsholongwane asebenza ngokuthe ngqo kwintsholongwane ye-hepatitis C (HCV) enze ukuba imiphunga ye-HCV ene-HCV-positive donor itshintshelwe ngokukhuselekileyo kubantu abangenayo i-HCV. Ngokufanayo, i-human immunodeficiency virus (HIV) positive donor lungs (HIV) positive donor lungs can be transplanted into HIV-positive receptors, and hepatitis B virus (HBV) positive donor lungs (HBV) positive lungs donor lungs can be transplanted to the granted to the receiver has been goven against HBV and those who are immune. Kukho iingxelo zofakelo lwemiphunga ezivela kubanikezeli abasebenzayo okanye ngaphambili abosulelekileyo yi-SARS-CoV-2. Sifuna ubungqina obuninzi ukuze siqinisekise ukhuseleko lokosulela imiphunga yomxhasi ngeentsholongwane ezosulelayo ukwenzela uqhaqho-fakelo.
Ngenxa yobunzima bokufumana amalungu amaninzi, kulucelomngeni ukuvavanya umgangatho wemiphunga yabaxhasi. Ukusebenzisa inkqubo ye-in vitro lung perfusion yokuvavanya ivumela uvavanyo oluthe kratya lomsebenzi wemiphunga yomnikezeli kunye nokukwazi ukuyilungisa ngaphambi kokusetyenziswa (Umfanekiso 2). Kuba umphunga womnikezeli usesichengeni kakhulu sokwenzakala, inkqubo ye-invitro lung perfusion ibonelela ngeqonga lolawulo lonyango oluthile lwebhayoloji ukulungisa umphunga womnikeli owonakeleyo (Umfanekiso 2). Ulingo olubini olungenamkhethe lubonise ukuba kwi-vitro iqondo lobushushu bomzimba obuqhelekileyo ukufakwa kwemiphunga kwimiphunga yomxhasi ehlangabezana nemilinganiselo eqhelekileyo ikhuselekile kwaye iqela lofakelo lotshintsho linokwandisa ixesha lokugcinwa ngale ndlela. Ukugcina imiphunga yomnikezeli kwi-hypothermia ephezulu (i-6 ukuya kwi-10 ° C) kunokuba i-0 ukuya kwi-4 ° C kwiqhwa kuye kwabikwa ukuba kuphuculwe impilo ye-mitochondrial, ukunciphisa umonakalo, kunye nokuphucula ukusebenza kwemiphunga. Ukutshintshwa kwe-semi-selective day, ukugcinwa kwexesha elide kuye kwaxelwa ukufezekisa iziphumo ezilungileyo emva kokutshintshwa. Ulingo olukhulu olungekho ngaphantsi lokhuseleko oluthelekisa ukugcinwa kwi-10 ° C kunye ne-cryopreservation esemgangathweni okwangoku iyaqhubeka (inombolo yokubhalisa i-NCT05898776 kwi-ClinicalTrials.gov). Abantu baqhubeka bekhuthaza ukubuyiswa kwamalungu ngexesha elifanelekileyo ngamaziko okunyamekela amaziko amaninzi kunye nokuphucula ukusebenza kwamalungu ngamaziko okulungisa amalungu, ukwenzela ukuba izitho ezisemgangathweni zingasetyenziselwa ukutshintshwa. Impembelelo yolu tshintsho kwi-ikhosistim yokufakelwa ngokutsha isavavanywa.
Ukuze kugcinwe amalungu e-DCD alawulwayo, ukuchithwa kwendawo yokushisa komzimba okuqhelekileyo kwi-situ nge-extracorporeal membrane oxygenation (ECMO) ingasetyenziselwa ukuvavanya umsebenzi wezitho zesisu kunye nokuxhasa ukufunyanwa ngokuthe ngqo kunye nokugcinwa kwezitho ze-thoracic, kubandakanywa nemiphunga. Amava kunye nokufakelwa kwemiphunga emva kwe-perfusion yendawo yobushushu bomzimba obuqhelekileyo kwisifuba kunye nesisu esincinci kwaye iziphumo zixutywe. Kukho iinkxalabo zokuba le nkqubo inokubangela umonakalo kubaxhasi abaswelekileyo kwaye yaphule imigaqo yokuziphatha esisiseko yokuvuna amalungu; Ngoko ke, ukufakelwa kwendawo kwiqondo lokushisa lomzimba eliqhelekileyo akukavunyelwa kumazwe amaninzi.

Umhlaza
Izehlo zomhlaza kuluntu emva kofakelo lwemiphunga ziphezulu kunabemi ngokubanzi, kwaye i-prognosis ithande ukuhlwempuzeka, ibalelwa kwi-17% yokusweleka. Umhlaza wemiphunga kunye nesifo se-post-transplant lymphoproliferative (PTLD) zezona zizathu zixhaphakileyo zokufa okunxulumene nomhlaza. I-immunosuppression yexesha elide, iziphumo zokutshaya kwangaphambili, okanye umngcipheko wesifo semiphunga esisiseko zonke zikhokelela kumngcipheko wokukhula komhlaza wemiphunga kumphunga womamkeli wemiphunga omnye, kodwa kwiimeko ezinqabileyo, umhlaza we-subclinical we-subclinical unokubakho kwimiphunga yokutshintshwa. Umhlaza wolusu we-non-melanoma ngowona mhlaza uxhaphakileyo phakathi kwabamkeli bokufakelwa, ngoko ke ukujongwa rhoqo komhlaza wolusu kubalulekile. I-B-cell PTLD ebangelwa yintsholongwane ka-Epstein-Barr ngunobangela obalulekileyo wezifo nokufa. Nangona i-PTLD inokusombulula nge-immunosuppression encinci, i-B-cell ejoliswe kunyango olujoliswe kuyo kunye ne-rituximab, i-systemic chemotherapy, okanye zombini ziyafuneka.
Ukusinda kunye neziphumo zexesha elide
Ukusinda emva kokutshintshwa kwemiphunga kuhlala kulinganiselwe xa kuthelekiswa namanye amalungu omzimba, kunye ne-median ye-6.7 iminyaka, kwaye inkqubela encinci yenziwe kwiziphumo zexesha elide zesigulane kwiminyaka engamashumi amathathu. Nangona kunjalo, izigulane ezininzi zafumana ukuphuculwa okuphawulekayo kumgangatho wobomi, isimo somzimba, kunye nezinye iziphumo ezichazwe ngesigulane; Ukuze kuqhutywe uvavanyo olubanzi lweziphumo zonyango lokutshintshwa kwemiphunga, kuyimfuneko ukunikela ingqalelo ngakumbi kwiziphumo ezichazwe zezi zigulana. Isidingo seklinikhi esibalulekileyo esingafezekiswanga kukujongana nokufa kommkeli ngenxa yeengxaki ezibulalayo zokulibaziseka kokusilela kwe-graft okanye ukugonywa ixesha elide. Kubantu abafumana ukufakelwa kwemiphunga, kufuneka kunikwe ukhathalelo olusebenzayo lwexesha elide, olufuna ukusebenzisana kweqela ukukhusela impilo yonke yommkeli ngokubeka iliso kunye nokugcina umsebenzi we-graft kwelinye icala, ukunciphisa imiphumo emibi yokugonywa kunye nokuxhasa impilo yengqondo kunye nengqondo yommkeli kwelinye icala (Umfanekiso 1).
Ulwalathiso lwexesha elizayo
Uqhaqho-fakelo lwemiphunga lunyango oluye lwahamba indlela ende ngexesha elifutshane, kodwa ayikafikeleli ngokupheleleyo kwisakhono salo. Ukunqongophala kwemiphunga efanelekileyo yomnikeli kusengumngeni omkhulu, kwaye iindlela ezintsha zokuvavanya kunye nokukhathalela abaxhasi, ukunyanga kunye nokulungiswa kwemiphunga yabaxhasi, kunye nokuphucula ukugcinwa komnikeli zisaphuhliswa. Kuyimfuneko ukuba kuphuculwe imigaqo-nkqubo yolwabiwo lwamalungu ngokuphucula ungqamaniso phakathi kwabaxhasi nabamkeli ukuze kunyuswe ngakumbi izibonelelo ezishiyekileyo. Kukho umdla okhulayo wokufumanisa ukwaliwa okanye usulelo ngokuxilonga imolekyuli, ngakumbi ngeDNA yasimahla evela kumxhasi, okanye ekukhokeleni ukuncitshiswa kokugonywa komzimba; Nangona kunjalo, ukusetyenziswa kolu xilongo njengenxalenye yeendlela zangoku zokujongwa kohlumelo lwezonyango kusafuneka kumiselwe.
Intsimi yokufakelwa kwemiphunga iye yaphuhliswa ngokusekwa kwee-consortiums (umzekelo, inombolo yobhaliso ye-ClinicalTrials.gov NCT04787822; https://lungtransplantconsortium.org) indlela yokusebenza kunye, iya kunceda ekuthinteleni kunye nonyango lokungasebenzi kakuhle kwe-graft, uqikelelo lwe-CLAD, ukuxilongwa kwangaphambili kunye nenkqubela phambili yophando lwe-faster syndrome, i-endofting ye-inner syndrome ukungasebenzi, ukwaliwa kwe-antibody-mediated, iindlela ze-ALAD kunye ne-CLAD. Ukunciphisa iziphumo ebezingalindelekanga kunye nokunciphisa umngcipheko we-ALAD kunye ne-CLAD ngonyango lobuqu lwe-immunosuppressive, kunye nokuchaza iziphumo ezigxile kwisigulane kunye nokubandakanya kwimilinganiselo yeziphumo, kuya kuba ngundoqo ekuphuculeni impumelelo yexesha elide yokutshintshwa kwemiphunga.