Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis
Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis
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DOI：
10.1164/rccm.200302-165oc
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发表时间：
2004-11-01
影响因子：
24.7
通讯作者：
Glanville, AR
中科院分区：
文献类型：
--
作者：
Hopkins, PM;Aboyoun, CL;Glanville, AR
肺移植受者微急性排斥反应(A级)的临床意义尚不清楚。我们前瞻性地分析了184名患者的1159例经支气管镜肺活检。术后平均229+/-340天，对279例患者进行了组织学检查，证实为A型。在255例监测A中，64例在3个月的随访中进展为高度急性排斥反应，而40例发展为新的淋巴细胞性毛细支气管炎。24例A，活检有症状，仅2例在类固醇治疗后进展为高度排斥反应。184名患者中有78名在移植后的头12个月内接受了多次(大于或等于2)A级活组织检查。有多个A(1)病变的患者中有68%的患者平均599+/-435天发生毛细支气管炎闭塞综合征，而有一个或更少A(1)病变的患者中有43%的患者平均819+/-526天发生毛细支气管炎闭塞综合征(p=0.022)。18名患者在移植后接受了多次A型活组织检查，没有发生严重的排斥反应，但也较早地发展为闭塞性毛细支气管炎(456d+/-245d，p=0.020)。我们的结论是，对于A(1)经支气管镜肺活检，即使在没有症状的患者中，传统的仅观察的治疗现在也受到了挑战。经历多个A(1)病变的患者较早发生闭塞性毛细支气管炎，并可能需要替代免疫抑制策略。
The clinical significance of minimal acute rejection (grade A,) in lung transplant recipients is unknown. We prospectively analyzed 1,159 transbronchial lung biopsies in 184 patients. Two hundred seventy-nine biopsies in 128 participants confirmed A, histology at a mean postoperative day of 229 +/- 340. Sixty four of 255 surveillance A, lesions progressed to high-grade acute rejection by 3 months of follow-up, whereas 40 developed new lymphocytic bronchiolitis. Twenty-four A, biopsies were symptomatic, with only two cases progressing to high-grade rejection after steroid therapy. Seventy-eight of 184 patients experienced multiple (greater than or equal to 2) A, biopsies in the first 12 months after transplant. Bronchiolitis obliterans syndrome developed in 68% of patients with multiple A(1) lesions at a mean of 599 +/- 435 days, compared with 43% of patients with one or less A, lesions at a mean of 819 +/- 526 (p = 0.022). Eighteen patients experienced multiple A, biopsies after transplant in the absence of high-grade rejection episodes yet also developed earlier obliterative bronchiolitis (456 +/- 245 days, p = 0.020). We conclude that for A(1) transbronchial lung biopsies, the conventional treatment of observation only is now challenged even in patients who are asymptomatic. Patients who experience multiple A(1) lesions develop an earlier onset of obliterative bronchiolitis and may warrant alternative immunosuppressive strategies.