THE PATHOLOGY OF COMBINED HEART-LUNG TRANSPLANTATION - AN AUTOPSY STUDY
THE PATHOLOGY OF COMBINED HEART-LUNG TRANSPLANTATION - AN AUTOPSY STUDY
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DOI：
10.1016/s0046-8177(88)80233-8
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发表时间：
1988-12-01
期刊：
影响因子：
3.3
通讯作者：
YOUSEM, SA
中科院分区：
文献类型：
--
作者：
TAZELAAR, HD;YOUSEM, SA
临床心肺移植（HLT）于1981年在斯坦福大学（斯坦福大学，CA）开始，并且从那时起，已经进行了超过40次HLT。目前全世界共有250个高级别小组。虽然接受HLT的患者发生的大部分病理学与接受其他移植器官系统的患者发生的病理学相似，但这些患者也发生了值得强调的独特临床并发症和病理过程。本文报告20例HLT受者的尸检结果，其中12例在HLT后1天至4个月死于医院。其中5例术后死亡的主要促成因素是既往胸部手术所致粘连导致的胸膜出血。压倒性的病毒和真菌感染导致6人死亡。第7例患者死于成人呼吸窘迫综合征（ARDS）。2例患者显示了再植反应的组织学证据。6名长期存活者死于闭塞性细支气管炎（OB）（平均生存期，22个月）。在4例患者中，OB是直接死亡原因，而1例患者死于并发性心肌梗死，另1例患者死于阑尾切除术并发症。两名长期存活者在无OB的情况下死亡，一名在63个月时死于医源性原因，另一名在52个月时死于不明原因的ARDS。两名无OB的患者的基础肺实质基本正常。所有长期存活者都有冠状动脉或肺血管内膜硬化，以及环孢霉素A毒性引起的肾脏病变。虽然在4例患者中观察到轻度急性肺和心脏排斥反应的组织学特征，但这些特征在任何情况下都不会导致死亡。虽然OB是其成功的主要威胁，但HLT是终末期肺病患者的可行选择。
Clinical heart-lung transplantation (HLT) began at Stanford University (Stanford, CA) in 1981, and since then, over 40 HLTs have been performed. There is now a worldwide total of 250 HLTs. While much of the pathology that occurs in patients receiving an HLT is similar to that which develops in patients with other transplanted organ systems, these patients also develop unique clinical complications and pathologic processes that deserve emphasis. We report the autopsy findings of 20 HLT recipients, of whome 12 died in hospital one day to 4 months post-HLT. A major contributing factor in five of these postoperative deaths was pleural hemorrhage from adhesions due to prior chest surgery. Overwhelming viral and fungal infections accounted for six deaths. The seventh patient died as a result of adult respiratory distress syndrome (ARDS). Two patients showed histologic evidence of the reimplantation response. Six long-term survivors died (mean survival, 22 months) with obliterative bronchiolitis (OB). In four patients, OB was the immediate cause of death, while one patient died of an intercurrent myocardial infarct, and the other patient died of complications from an appendectomy. Two long-term survivors died without OB, one of iatrogenic causes at 63 months and the second due to unexplained ARDS at 52 months. Both patients without OB had virtually normal underlying pulmonary parenchyma. All of the long-term survivors had either coronary arterial or pulmonary vascular intimal sclerosis, and renal lesions attributable to cyclosporine A toxicity. Although histologic features of mild acute pulmonary and cardiac rejection were observed in four patients overall, these did not contribute to the cause of death in any case. Although OB is a major threat to its success, HLT is a viable option for patients with endstage pulmonary disease.