Recurrence of sarcoidosis in pulmonary allograft recipients.
Recurrence of sarcoidosis in pulmonary allograft recipients.
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肺同种异体移植受者结节病的复发。
DOI：
10.1164/ajrccm/148.5.1373
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Griffith,BP
中科院分区：
文献类型：
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作者：
Johnson,BA;Duncan,SR;Ohori,NP;Paradis,IL;Yousem,SA;Grgurich,WF;Dauber,JH;Griffith,BP
肺移植是治疗结节病终末期肺部后遗症的一种潜在治疗方法。我们回顾了匹兹堡大学医学中心的5例肺移植受者的病程，并将其与44例同期移植受者的对照组（C）进行了比较。在4S的同种异体移植物中出现了结节病肉芽肿，尽管这些病变尚未被证明会导致临床显著的异常。与C组相比，结节病患者在移植后的前3个月内的急性排斥反应的平均分级显著更高（S和C分别为2.1 ± 0.3和1.6 ± 0.1，p < 0.042），肺活检显示超过轻度急性排斥反应的比例更高（40对18%，p < 0.012）和淋巴细胞性支气管炎（30对13%，p = 0.02），以及BAL回血中多形核白细胞百分比更高（34.9 ± 5.4对19.0 ± 1.6，p < 0.01）。然而，两组在闭塞性细支气管炎的发生率、生存率或肺功能方面没有差异。我们的结论是，肺移植受者与潜在的结节病是非常有可能发展复发性疾病的同种异体移植物，并有更严重的急性排斥反应，特别是在移植后的第一周。肺移植似乎是终末期结节病的有效治疗方法，但移植物中急性排斥反应增加和结节病复发的长期后遗症仍有待确定。
Lung transplantation is a potentially curative therapy for the end-stage pulmonary sequelae of sarcoidosis. We reviewed the course of five lung allograft recipients with underlying sarcoidosis (S) at the University of Pittsburgh Medical Center and compared them with a control group (C) of 44 contemporaneous transplant recipients with other respiratory diseases. Sarcoid granulomata have developed in the allografts of 4 S, although these lesions have not yet been demonstrated to result in clinically significant abnormalities. In comparison with C, sarcoidosis patients had significantly greater mean grades of acute rejection during the first 3 months after transplantation (2.1 ± 0.3 versus 1.6 ± 0.1, S and C, respectively, p < 0.042) and larger proportions of lung biopsies showing more than mild acute rejection (40 versus 18%, p < 0.012) and lymphocytic bronchitis (30 versus 13%, p = 0.02), as well as a greater percentage of polymorphonuclear leukocytes in BAL returns (34.9 ± 5.4 versus 19.0 ± 1.6, p < 0.01). The two groups did not differ, however, in frequency of obliterative bronchiolitis, survival, or pulmonary function. We conclude that lung transplant recipients with underlying sarcoidosis are very likely to develop recurrent disease in the allograft and have more severe acute rejection responses, especially in the first weeks after transplantation. Pulmonary transplantation appears to be an efficacious therapy for end-stage sarcoidosis, but the long-term sequelae of the increased acute rejection and recurrent sarcoidosis in the allograft remain to be determined.