Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation
Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation
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DOI：
10.1164/rccm.200706-951oc
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发表时间：
2008-05-01
影响因子：
24.7
通讯作者：
Malouf, Monique A.
中科院分区：
文献类型：
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作者：
Glanville, Allan R.;Aboyoun, Christina L.;Malouf, Monique A.
理由：肺同种异体移植严重和复发性急性血管排斥反应是闭塞性细支气管炎的一个公认的主要危险因素。目的：我们评估淋巴细胞性细支气管炎作为肺移植后闭塞性细支气管炎综合征（BOS）和死亡的危险因素的作用。方法：回顾性分析1995-2005年间341例肺移植术后90天存活患者的1770例经支气管肺活检。测量和主要结果：经支气管活检显示130级（正常）（n = 501）， B1级（轻度）（n = 762）， B2级（轻度）（n = 176）， B3级（中度）（n = 70）， B4级（重度）（n = 4）淋巴细胞性细支气管炎，Bx级（无细支气管组织）（n = 75）。182例经支气管活检未分级（8例诊断不充分，142例巨细胞病毒，32例其他诊断）。肺移植受者按诊断前B级最高分为B0 （n = 12）、131 （n = 166）、B2 （n = 89）、B3-B4 （n = 51）。23个是无法分类的。累积的BOS发病率和死亡率依赖于最高的B级（Kaplan-Meier, P < 0.001, log-rank）。多变量Cox比例风险分析显示，BOS的显著风险为最高B级（相对危险度[RR]， 1.62； 95%可信区间[Cl]， 1.31-2.00） （P < 0.001）、较长的缺血时间（RR, 1.00; Cl, 1.00-1.00） （P < 0.05）和最近移植年份（RR, 0.93; Cl, 0.87-1.00） （P < 0.05），而死亡风险为BOS作为时间相关协变量（RR, 19.10; Cl, 11.07-32.96） （P < 0.001）和最高B级（RR, 1.36; Cl, 1.07-1.72） （P < 0.05）。急性血管排斥反应在两种模型中都不是显著的危险因素。结论：淋巴细胞性细支气管炎的严重程度与肺移植术后BOS和死亡的风险增加相关，不依赖于急性血管排斥反应。
Rationale: Severe and recurrent acute vascular rejection of the pulmonary allograft is an accepted major risk factor for obliterative bronchiolitis.Objectives: We assessed the role of lymphocytic bronchiolitis as a risk factor for bronchiolitis obliterans syndrome (BOS) and death after lung transplantation.Methods: Retrospective analysis of 341 90-day survivors of lung transplant performed in 1995-2005 who underwent 1,770 trans-bronchial lung biopsy procedures.Measurements and Main Results: Transbronchial biopsies showed grade 130 (normal) (n = 501), B1 (minimal) (n = 762), B2 (mild) (n = 176), B3 (moderate) (n = 70), B4 (severe) (n = 4) lymphocytic bronchiolitis, and Bx (no bronchiolar tissue) (n = 75). A total of 182 transbronchial biopsies were ungraded (8 inadequate, 142 cytomegalovirus, 32 other diagnoses). Lung transplant recipients were grouped by highest B grade before diagnosis of BOS: B0 (n = 12), 131 (n = 166), B2 (n = 89), and B3-B4 (n = 51). Twenty-three were un-classifiable. Cumulative incidence of BOS and death were dependent on highest B grade (Kaplan-Meier, P < 0.001, log-rank). Multivariable Cox proportional hazards analysis showed significant risks for BOS were highest B grade (relative risk [RR], 1.62; 95% confidence interval [Cl], 1.31-2.00) (P < 0.001), longer ischemic time (RR, 1.00; Cl, 1.00-1.00) (P < 0.05), and recent year of transplant (RR, 0.93; Cl, 0.87-1.00) (P < 0.05), whereas risks for death were BOS as a time-dependent covariable (RR, 19.10; Cl, 11.07-32.96) (P < 0.001) and highest B grade (RR, 1.36; Cl, 1.07-1.72) (P < 0.05). Acute vascular rejection was not a significant risk factor in either model.Conclusions: Severity of lymphocytic bronchiolitis is associated with increased risk of BOS and death after lung transplantation independent of acute vascular rejection.