Hachem Ramsey R, Khalifah Anthony P, Chakinala Murali M, Yusen Roger D, Aloush Aviva A, Mohanakumar Thalachallour, Patterson G Alexander, Trulock Elbert P, Walter Michael J
Division of Pulmonary and Critical Care, Washington University School of Medicine, St. Louis, MO 63110, USA.
Transplantation. 2005 Nov 27;80(10):1406-13. doi: 10.1097/01.tp.0000181161.60638.fa.
Bronchiolitis obliterans syndrome (BOS) remains the leading obstacle to better long-term outcomes after lung transplantation. Acute rejection has been identified as the primary risk factor for BOS, but the impact of minimal acute rejection, especially a solitary episode, has usually been discounted as clinically insignificant.
We performed a retrospective cohort study of 259 adult lung transplant recipients to determine the risk of BOS associated with a single episode of A1 rejection, without recurrence or subsequent progression to a higher grade. The cohort was divided into 3 groups based on the severity of acute rejection (none, single episode of A1, and single episode of A2). We determined the risks of BOS stages 1, 2, 3, and death for each group using univariate and multivariate Cox regression analyses.
A solitary episode of A1 rejection was a significant risk factor for BOS stages 1 and 2, but not stage 3 or death, in the univariate analysis. Multivariate Cox regression models confirmed that the risk of BOS attributable to a single episode of A1 rejection was independent of other potential risk factors, such as community acquired respiratory viral infections, number of HLA mismatches, and cytomegalovirus pneumonitis. Likewise, univariate and multivariate analyses demonstrated that a single episode of A2 rejection was a significant risk factor for all stages of BOS but not death.
A single episode of minimal acute rejection without recurrence or subsequent progression to a higher grade is a significant predictor of BOS independent of other risk factors.
闭塞性细支气管炎综合征（BOS）仍然是肺移植后实现更好长期预后的主要障碍。急性排斥反应已被确定为BOS的主要危险因素，但轻微急性排斥反应的影响，尤其是单次发作，通常被认为临床意义不大而被忽视。
我们对259例成年肺移植受者进行了一项回顾性队列研究，以确定与单次A1级排斥反应相关的BOS风险，且无复发或随后进展为更高等级。根据急性排斥反应的严重程度（无、单次A1级、单次A2级）将队列分为3组。我们使用单变量和多变量Cox回归分析确定每组BOS 1期、2期、3期及死亡的风险。
在单变量分析中，单次A1级排斥反应是BOS 1期和2期的显著危险因素，但不是3期或死亡的危险因素。多变量Cox回归模型证实，单次A1级排斥反应导致BOS的风险独立于其他潜在危险因素，如社区获得性呼吸道病毒感染、HLA错配数量和巨细胞病毒性肺炎。同样，单变量和多变量分析表明，单次A2级排斥反应是BOS各阶段的显著危险因素，但不是死亡的危险因素。
无复发或随后进展为更高等级的单次轻微急性排斥反应是独立于其他危险因素的BOS显著预测因素。
