Lung transplantation is a complex surgical procedure that a diseased lung is removed and replaced with a donor lung through anastomosis. In context of transplantation, a patient will receive either a single or bilateral lung transplant from a deceased donor. The current concern for lung transplantation is the shortage of lungs donor. Fortunately, some cases could be relieved by receiving donation from living donors. This procedure involved the removal of one lower lobes of lungs each from two living donors, and transplant them to the patient. Lung transplantation are usually an option for patients with advanced lung diseases, not responding to the maximum treatments, and their life expectancy are estimated to be less than three years. These
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Furthermore, the postoperative period is critical to patients even they had withstood the surgery. This is because lung transplantation associated with early and late postoperative injuries such as infection, rejection, and other complications. Rejection is a common condition of post-surgery due to the induction of immune system against the foreign donor lung. On the contrary, infection is commonly a result from consumption of medication that suppress the immune system. Immunosuppressive drug containing ciclosporin, azathioprine, and corticosteroids or antithymocyte globulin are prescribed to prevent rejection on donor lungs. However, the immune system is weaken and more vulnerable to infectious pathogens. In context of innate immune responses, a literature demonstrated that an inhibition of Toll-like receptors (TLRs) debilitate allograft rejection, while TLR activation and recognition by innate pattern recognition receptors (PRRs) impedes successful transplant tolerance. On the other hand, TLR signalling and Toll-like receptor-4 (TLR-4) polymorphisms were also found linked to allograft rejection and development of acute rejection.1 Moreover, immunosuppression on specialized cell-mediated immunity that equipped with TLRs and PRRs attenuate immune responses to toxins and infections. Patients suffer from rejection or infection often accompanied with clinical manifestation such as malaise, pyrexia, abnormal findings on chest X-ray, and impaired lung function. Several detection measurements are used to identify these post-transplantation complications. For instances, transbronchial biopsy (TBBx), thoracic imaging, polymerase chain reaction (PCR), and pulmonary function tests
Furthermore, the postoperative period is critical to patients even they had withstood the surgery. This is because lung transplantation associated with early and late postoperative injuries such as infection, rejection, and other complications. Rejection is a common condition of post-surgery due to the induction of immune system against the foreign donor lung. On the contrary, infection is commonly a result from consumption of medication that suppress the immune system. Immunosuppressive drug containing ciclosporin, azathioprine, and corticosteroids or antithymocyte globulin are prescribed to prevent rejection on donor lungs. However, the immune system is weaken and more vulnerable to infectious pathogens. In context of innate immune responses, a literature demonstrated that an inhibition of Toll-like receptors (TLRs) debilitate allograft rejection, while TLR activation and recognition by innate pattern recognition receptors (PRRs) impedes successful transplant tolerance. On the other hand, TLR signalling and Toll-like receptor-4 (TLR-4) polymorphisms were also found linked to allograft rejection and development of acute rejection.1 Moreover, immunosuppression on specialized cell-mediated immunity that equipped with TLRs and PRRs attenuate immune responses to toxins and infections. Patients suffer from rejection or infection often accompanied with clinical manifestation such as malaise, pyrexia, abnormal findings on chest X-ray, and impaired lung function. Several detection measurements are used to identify these post-transplantation complications. For instances, transbronchial biopsy (TBBx), thoracic imaging, polymerase chain reaction (PCR), and pulmonary function tests