Audit of referral and explant diagnoses in lung transplantation: a pathologic study of lungs removed for parenchymal disease.
Audit of referral and explant diagnoses in lung transplantation: a pathologic study of lungs removed for parenchymal disease.
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肺移植中转诊和外植体诊断的审核：因实质疾病而切除的肺的病理学研究。
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
J. Wallwork
中科院分区：
文献类型：
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作者：
Susan Stewart;K. McNeil;S. Nashef;F. Wells;T. Higenbottam;J. Wallwork
背景
肺移植用于越来越多的肺部疾病，其中诊断通常是临床的或基于有限的活检材料。诊断可以在疾病的后期进行，其中特定特征不再存在。移植后并发症和疾病复发可能与原发病有关，因此准确的诊断至关重要。
方法和结果
对10年内183例肺移植患者（心肺= 109例，单肺= 65例，双肺= 9例）的病理学回顾显示，29例显著差异或可能影响结局的其他特征。最终病理诊断为囊性纤维化（n = 66）、肺气肿（n = 59）、支气管扩张（n = 17）、肺纤维化（n = 19）、结节病（n = 10）、朗格汉斯细胞组织细胞增多症（n = 19）、肺静脉闭塞性疾病（n = 10）、移植后闭塞性细支气管炎（n = 19）、原发性含铁血黄素沉着症（n = 17）、类风湿闭塞性细支气管炎（n = 19）、外源性过敏性肺泡炎（n = 10）、移植后闭塞性细支气管炎（n = 19）、原发性含铁血黄素沉着症（n = 17）、类风湿闭塞性细支气管炎（n = 19）、外源性过敏性肺泡炎（n = 19）、尘肺（1例）。未被怀疑的诊断包括结核病（8例）（其中4例为活动性，在单肺接受者中需要抗结核化疗）、结节病（9例）（其中6例为未被怀疑的初步诊断，3例为额外诊断）、静脉闭塞性疾病（3例）、癌症（1例）、尘肺病（1例）和肺纤维化（2例）。囊性纤维化患者中发现曲霉菌感染（2例）和支气管中心性肉芽肿病（3例）。1例活动性肺结核病例还显示曲菌球。免疫抑制患者中需要治疗的未被怀疑的感染和以前未被怀疑的结节病（已知在移植物中复发）是主要的新诊断。单肺中的离散率为12/65（19%），心肺中的离散率为17/109（16%）。
结论
这些结果强调需要准确的术前诊断，特别是当类似病变的原生肺仍然在原位。
BACKGROUND
Lung transplantation is performed for an increasing range of pulmonary conditions in which the diagnosis is often clinical or based on limited biopsy material. Diagnosis may be made late in the course of the disease where specific features are no longer present. Posttransplantation complications and disease recurrence may relate to the primary disease, and accurate diagnosis is therefore essential.
METHODS AND RESULTS
A pathologic review of 183 explanted lungs over a 10-year period (heart-lung = 109, single lung = 65, double lung = 9) showed 29 significant discrepancies or additional features likely to effect outcome. The final pathologic diagnosis was cystic fibrosis (n = 66), emphysema (59), bronchiectasis (17), pulmonary fibrosis (19), sarcoidosis (10), Langerhans cell histiocytosis (3), pulmonary veno-occlusive disease (3), posttransplantation obliterative bronchiolitis (2), primary hemosiderosis (1), rheumatoid obliterative bronchiolitis (1), extrinsic allergic alveolitis (1), pneumoconiosis (1). Unsuspected diagnoses included tuberculosis (8) (four cases of which were active and in single lung recipients requiring antituberculous chemotherapy), sarcoidosis (9), (of which, six were unsuspected primary diagnoses and three were additional diagnoses), veno-occlusive disease (3), carcinoma (1), pneumoconiosis (1), and pulmonary fibrosis (2). Aspergillus infection (2) and bronchocentric granulomatosis (3) were found in patients with cystic fibrosis. One active tuberculosis case also showed an aspergilloma. Unsuspected infections requiring therapy in immunosuppressed patients and previously unsuspected sarcoidosis, which is known to recur in the graft, were the major novel diagnoses. Discrepancy rate was 12 of 65 in single lungs (19%) and 17 of 109 in heart-lungs (16%).
CONCLUSIONS
These results emphasize the need for accurate preoperative diagnosis especially when the similarly diseased native lung remains in situ.