Mathur Amit, Baz Maher, Staples E Denmark, Bonnell Mark, Speckman Jerry M, Hess Phillip J, Klodell Charles T, Knauf Daniel G, Moldawer Lyle L, Beaver Thomas M
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, USA.
Ann Thorac Surg. 2006 May;81(5):1844-9; discussion 1849-50. doi: 10.1016/j.athoracsur.2005.11.053.
Post-lung transplant reperfusion edema (PLTRE) and its more severe form, primary graft failure (PGF), occur in 10% to 60% of lung transplant recipients. We hypothesized that PLTRE and PGF would be associated with an elevated proinflammatory cascade and that the allograft would be the source of cytokine appearance in the circulation.
Pulmonary arterial and systemic arterial samples were obtained at baseline and at 4, 8, and 24 hours after reperfusion. Post-lung transplant reperfusion-edema and PGF were defined as PaO2/FiO2 less than 300 with a mild or moderate infiltrate, or less than 200 with a severe infiltrate and ventilator dependence after 72 hours, respectively. Tumor necrosis factor alpha (TNFalpha), interleukin (IL)-6, IL-8, and IL-10 concentrations were determined by immunoassay.
Fifteen single and 6 bilateral lung recipients were studied. Six (29%) had PLTRE and 4 (19%) had PGF; these patients had an overall elevation in plasma IL-6, IL-8, and IL-10 concentrations (all p < 0.05). Subgroup analysis revealed a significantly greater elevation in IL-6, IL-8, and IL-10 levels in PGF patients (all p < 0.01) versus PLTRE. In the PGF group, TNFalpha and IL-10 concentrations were significantly greater in the systemic versus the pulmonary arterial samples (p < 0.05).
Patients with PLTRE and PGF exhibited graded increases in IL-6, IL-8, and IL-10 concentrations. The PGF patients had higher TNFalpha and IL-10 systemic arterial concentrations overall, consistent with the allograft being a source of this cytokine production.
肺移植再灌注水肿（PLTRE）及其更严重的形式，即原发性移植肺功能衰竭（PGF），发生于10%至60%的肺移植受者中。我们推测PLTRE和PGF与促炎级联反应升高有关，并且移植肺将是循环中细胞因子出现的来源。
在基线以及再灌注后4小时、8小时和24小时获取肺动脉和体动脉样本。肺移植再灌注水肿和PGF分别定义为72小时后氧分压/吸入氧分数值（PaO2/FiO2）小于300且伴有轻度或中度浸润，或小于200且伴有重度浸润并依赖呼吸机。通过免疫测定法测定肿瘤坏死因子α（TNFα）、白细胞介素（IL）-6、IL-8和IL-10的浓度。
研究了15名单肺和6名双肺受者。6名（29%）发生PLTRE，4名（19%）发生PGF；这些患者血浆IL-6、IL-8和IL-10浓度总体升高（均p<0.05）。亚组分析显示，与PLTRE患者相比，PGF患者的IL-6、IL-8和IL-10水平升高更为显著（均p<0.01）。在PGF组中，体动脉样本中的TNFα和IL-10浓度显著高于肺动脉样本（p<0.05）。
发生PLTRE和PGF的患者IL-6、IL-8和IL-10浓度呈分级升高。PGF患者总体上体动脉TNFα和IL-10浓度更高，这与移植肺是这种细胞因子产生的来源一致。
