Glanville Allan R, Gencay Mesut, Tamm Michael, Chhajed Prashant, Plit Marshall, Hopkins Peter, Aboyoun Christina, Roth Michael, Malouf Monique
Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
J Heart Lung Transplant. 2005 Feb;24(2):131-6. doi: 10.1016/j.healun.2003.09.042.
Chlamydia pneumoniae is established as a common agent of acute respiratory tract infection and has been implicated in the pathogenesis of asthma and chronic obstructive pulmonary disease. Airway disease is a prominent cause of morbidity and mortality after lung transplantation. We investigated the role of C pneumoniae as a pulmonary pathogen after lung transplantation.
Eighty lung transplant recipients underwent 232 bronchoscopies with bronchoalveolar lavage with or without transbronchial lung biopsy during 1 year for surveillance of rejection and infection, or where clinically indicated.
C pneumoniae was detected using nested polymerase chain reaction in 9 of 36 (25%) recipients studied within 30 days of lung transplantation, 3 of whom remained positive on repeat lavage and died from airway disease in the first year post-operatively. By comparison, all 27 recipients with negative lavage survived >1 year. Lavage was positive for C pneumoniae in 18 of 71 (25%) recipients studied >30 days after lung transplantation, 5 of whom had pneumonia and 8 of whom had bronchiolitis obliterans syndrome. Eleven also had acute pulmonary allograft rejection.
Persistent infection with C pneumoniae (whether donor-derived, de novo or re-activated) appears deleterious to pulmonary allograft function and is associated with early mortality, rejection and bronchiolitis obliterans syndrome after lung transplantation. A trial of empiric antibiotic therapy for C pneumoniae may therefore be warranted in the attempt to prevent progressive inflammatory airway disease.
肺炎衣原体已被确认为急性呼吸道感染的常见病原体，并与哮喘和慢性阻塞性肺疾病的发病机制有关。气道疾病是肺移植后发病和死亡的主要原因。我们研究了肺炎衣原体作为肺移植后肺部病原体的作用。
80例肺移植受者在1年内接受了232次支气管镜检查，进行支气管肺泡灌洗，部分伴有或不伴有经支气管肺活检，以监测排斥反应和感染，或根据临床指征进行检查。
在肺移植后30天内接受研究的36例受者中，有9例（25%）通过巢式聚合酶链反应检测到肺炎衣原体，其中3例在重复灌洗时仍为阳性，并在术后第一年死于气道疾病。相比之下，所有灌洗结果为阴性的27例受者存活时间均超过1年。在肺移植后30天以上接受研究的71例受者中，有18例（25%）灌洗结果为肺炎衣原体阳性，其中5例患有肺炎，8例患有闭塞性细支气管炎综合征。11例还发生了急性肺移植排斥反应。
肺炎衣原体持续感染（无论是供体来源、新发还是再激活）似乎对肺移植功能有害，并与肺移植后的早期死亡、排斥反应和闭塞性细支气管炎综合征有关。因此，为预防进行性炎症性气道疾病，可能有必要对肺炎衣原体进行经验性抗生素治疗试验。
