Pattern and predictors of early rejection after lung transplantation
Pattern and predictors of early rejection after lung transplantation
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DOI：
10.4037/ajcc2003.12.6.497
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发表时间：
2003-11-01
影响因子：
2.7
通讯作者：
Dauber, JH
中科院分区：
文献类型：
--
作者：
Dabbs, AD;Hoffman, LA;Dauber, JH
背景大多数肺移植受者的基础肺部状况得到改善，但面临着同种异体移植排斥反应的威胁，这是长期生存的主要决定因素。几项研究探讨了排斥反应的预测因素，但很少关注移植后早期。结论描述移植后第一年早期排斥反应的模式和预测因素，以指导干预措施的发展，促进早期发现和治疗排斥反应。方法回顾性检索供者、受体和移植后变量的数据，结果大多数受者（85%）至少发生过1次急性排斥反应，33%为单次，23%为复发性排斥反应，3%为持续性排斥反应，13%为难治性排斥反应，13%为急性排斥反应。14%有慢性排斥反应的临床病理证据。严重排斥反应（难治性急性排斥反应或慢性排斥反应）发生在27%的受者。与其他受者相比，发生严重排斥反应的受者发生急性排斥反应的次数更多（P = .004），首次急性发作发生在移植后不久（P = 0.01），且等级较高（P = .002）。结论：首次急性排斥反应分级较高的受者（P = 0.03）和较高的累积排斥评分（P = 0.004）比其他受者在移植后第一年内发生严重排斥的可能性明显更大。
BACKGROUND Most lung transplant recipients experience improvement in their underlying pulmonary condition but are faced with the threat of allograft rejection, the primary determinant of long-term survival. Several studies examined predictors of rejection, but few focused on the early period after transplantation.OBJECTIVES To describe the pattern and predictors of early rejection during the first year after transplantation to guide the development of interventions to facilitate earlier detection and treatment of rejection.METHODS Data for donor, recipient, and posttransplant variables were retrieved retrospectively,for 250 recipients of single or double lung transplants.RESULTS Most recipients (85%) had at least 1 episode of acute rejection; 33% had a single episode; 23% had recurrent rejection; 3% had persistent rejection; 13% had refractory rejection; and 14% had clinicopathological evidence of chronic rejection. Serious rejection (refractory acute rejection or chronic rejection) developed in 27% of recipients. Compared with other recipients, recipients who had serious rejection had more episodes of acute rejection (P = .004), and the first acute episodes occurred sooner after transplantation (P = .01) and were of a higher grade (P = .002).CONCLUSIONS Recipients who experienced higher grades for their first episode of acute rejection (P = .03) and higher cumulative rejection scores (P = .004) were significantly more likely than other recipients to have serious rejection during the first year after transplantation.