肺移植术后监测支气管镜检查对急性排斥反应和淋巴细胞性支气管炎/细支气管炎的诊断率

Yield of surveillance bronchoscopy for acute rejection and lymphocytic bronchitis/bronchiolitis after lung transplantation.

作者信息

Chakinala Murali M, Ritter Jon, Gage Brian F, Lynch John P, Aloush Aviva, Patterson G Alexander, Trulock Elbert P

机构信息

Division of Pulmonary and Critical Care Medicine, Saint Louis, Missouri 63110, USA.

出版信息

J Heart Lung Transplant. 2004 Dec;23(12):1396-404. doi: 10.1016/j.healun.2003.09.018.

DOI:10.1016/j.healun.2003.09.018

PMID:15607670

Abstract

BACKGROUND

Better understanding of the timing and pattern of surveillance bronchoscopy findings after lung transplantation could influence the timing and frequency of surveillance bronchoscopy. We present our surveillance bronchoscopy experience and test the hypothesis that patients not encountering early acute rejection or lymphocytic bronchitis/bronchiolitis are less likely to have subsequent occult occurrences in the 1st year after lung transplantation.

METHODS

We conducted a retrospective study of 204 patients who underword transplantation between 1996 and 2000. Based on contemporary biopsy-specimen grading in the first 100 days, we formed 2 groups: No Early Rejection and Early Rejection. We compared subsequent yields of surveillance bronchoscopy and the incidence of acute rejection or of lymphocytic bronchitis/bronchiolitis.

RESULTS

We reviewed 645 biopsies taken from 204 recipients during the first 100 days to classify patients into a No Early Rejection Group (n=67) or an Early Rejection Group (n=137). Yield of surveillance bronchoscopy for acute rejection or lymphocytic bronchitis/bronchiolitis was 31% with the greatest yield during the first 30 days (45%), and then decreasing to 26% (p <0.001). After Day 100, 71% of occult acute rejection episodes involved minimal (A1) lesions. Yield of surveillance bronchoscopy after Day 100 was 20% in the No Early Rejection Group and was 27% in the Early Rejection Group (p=0.22). Incidence of acute rejection or lymphocytic bronchitis/bronchiolitis after Day 100 was 41% in the No Early Rejection Group and was 50% in the Early Rejection Group (p=0.17).

CONCLUSION

Surveillance bronchoscopy detects occult acute rejection or lymphocytic bronchitis/bronchiolitis in approximately one-third of biopsy specimens during the 1st year, with the majority of late abnormalities being minimal (A1) rejection. The absence of acute rejection or lymphocytic bronchitis/bronchiolitis during the first 100 days does not predict freedom from such events in the remainder of the 1st year.

摘要

背景

更好地了解肺移植后监测性支气管镜检查结果的时间和模式，可能会影响监测性支气管镜检查的时间和频率。我们介绍了我们的监测性支气管镜检查经验，并检验了这样一个假设：在肺移植后的第1年中，未发生早期急性排斥反应或淋巴细胞性支气管炎/细支气管炎的患者发生后续隐匿性病变的可能性较小。

方法

我们对1996年至2000年间接受移植的204例患者进行了一项回顾性研究。根据最初100天内的当代活检标本分级，我们将患者分为两组：无早期排斥反应组和早期排斥反应组。我们比较了监测性支气管镜检查的后续活检阳性率以及急性排斥反应或淋巴细胞性支气管炎/细支气管炎的发生率。

结果

我们回顾了在最初100天内从204例受者身上获取的645份活检标本，将患者分为无早期排斥反应组（n = 67）或早期排斥反应组（n = 137）。监测性支气管镜检查发现急性排斥反应或淋巴细胞性支气管炎/细支气管炎的活检阳性率为31%，在最初30天内阳性率最高（45%），然后降至26%（p <0.001）。在第100天之后，71%的隐匿性急性排斥反应发作涉及微小（A1）病变。第100天之后，无早期排斥反应组的监测性支气管镜检查活检阳性率为20%，早期排斥反应组为27%（p = 0.22）。第100天之后，无早期排斥反应组急性排斥反应或淋巴细胞性支气管炎/细支气管炎的发生率为41%，早期排斥反应组为50%（p = 0.17）。