Long-term follow-up after total lymphoid irradiation in pediatric heart transplant recipients
Long-term follow-up after total lymphoid irradiation in pediatric heart transplant recipients
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DOI：
10.1016/s1053-2498(01)00772-0
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发表时间：
2002-06-01
影响因子：
8.9
通讯作者：
Bernstein, D
中科院分区：
文献类型：
--
作者：
Chin, C;Hunt, S;Bernstein, D
背景：全淋巴照射（TLI）用于治疗移植物复发性排斥反应。在儿童和成人心脏移植人群中报告了短期成功率和并发症发生率。我们报告的长期疗效和安全性的TLI治疗顽固性排斥反应的儿科patients.Methods：8例患儿接受TLI治疗（7例复发性排斥反应，1例药物不依从的风险）。治疗包括使用6 MeV线性加速器采用前后相对技术给予8戈伊的中平面剂量。我们回顾了总共40个病人年的随访结果。结果：在TLI前90天内进行的活检中，我们遇到了56.7% +/- 34.7%的排斥反应（国际心肺移植协会标准> 2级）。在治疗后的前90天内，排斥率下降至3.1% +/- 8.8%（p < 0.005），在完成TLI后的第一年内，排斥率保持在5.6% +/- 1.3%（p < 0.05）。从TLI到随后第一次排斥反应发作的中位时间为305天（范围，77- 1，920天）。5例患者的长期随访（>3年）表明排斥反应的发生率持续较低。TLI.Conclusions：全淋巴照射是一种有效的治疗复发性排斥反应的方法，具有短期和长期疗效。病理事件可能包括癌症、移植冠状动脉疾病和限制性心肌病。
Background: Total lymphoid irradiation (TLI) is used to treat recurrent allograft rejection. Short-term success and complication rates have been reported in pediatric and adult cardiac transplant populations. We report the long-term efficacy and safety of TLI in treating intractable rejection in pediatric patients.Methods: Eight pediatric patients were treated with TLI (7 for recurrent rejection, I for risk of medication non-compliance). Therapy consisted of a mid-plane dose of 8 Gy administered with a 6-MeV linear accelerator using an anterior-posterior opposed technique. We reviewed outcomes for a total of 40 patient-years of follow-up.Results: We encountered rejection (>Grade 2 by International Society for Heart and Lung Transplantation criteria) in 56.7% +/- 34.7% of biopsies performed within 90 days before TLI. Rejection rates dropped to 3.1% +/- 8.8% within the first 90 days (p < 0.005) after therapy and remained low at 5.6% +/- 1.3% (p < 0.05) during the first year after completion of TLI. Median time from TLI to the first subsequent rejection episode was 305 days (range, 77-1,920 days). Long-term follow-up (>3 years) of 5 patients demonstrated a continuing low incidence of rejection. Non-Hodgkin's lymphoma was diagnosed in 1 of 8 patients, graft coronary artery disease in 4 of 8 patients, and restrictive cardiomyopathy in 1 of 8 patients after TLI.Conclusions: Total lymphoid irradiation is an effective treatment for recurrent rejection and has short- and long-term efficacy. Morbid events may include cancer, graft coronary artery disease, and restrictive cardiomyopathy.