Abernathy E C, Hruban R H, Baumgartner W A, Reitz B A, Hutchins G M
Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21205.
Hum Pathol. 1991 Nov;22(11):1102-10. doi: 10.1016/0046-8177(91)90262-n.
Bronchiolitis obliterans has emerged as the major long-term complication of heart-lung transplantation. We reviewed the histologic findings in lungs obtained from 11 patients who had received a combined heart-lung transplant at The Johns Hopkins Hospital. Ten lungs were obtained at autopsy, and one was obtained from a patient who was retransplanted because of severe bronchiolitis obliterans. Bronchiolitis obliterans was identified in seven of these 11 lungs. Three of the seven lungs with bronchiolitis obliterans were from patients who had received their transplants more than 6 months previously; the bronchiolitis obliterans in these patients was characterized by a relatively acellular concentric fibrosing process that was limited to the terminal bronchioles. The bronchiolitis obliterans in these three patients was felt to be secondary to chronic lung allograft rejection. Four of the seven patients with bronchiolitis obliterans had received their transplants less than 6 months previously; the bronchiolitis obliterans in these patients was focal and cellular. It extended into the distal alveolar spaces and, in several cases, was associated with aspirated material and foreign body-type giant cells. All four of these patients had concurrent infections, aspiration, or large airway obstruction, which were felt to be responsible for the development of bronchiolitis obliterans. Bronchiolitis obliterans in lung allograft recipients may have a variety of etiologies, and the etiology of this process in a particular case can often be deduced by the morphologic appearance of this lesion.
闭塞性细支气管炎已成为心肺移植的主要长期并发症。我们回顾了在约翰霍普金斯医院接受心肺联合移植的11例患者的肺组织学检查结果。其中10例肺组织是在尸检时获得的，1例来自因严重闭塞性细支气管炎而接受再次移植的患者。在这11例患者的肺组织中，有7例发现了闭塞性细支气管炎。7例患有闭塞性细支气管炎的患者中，有3例是在移植6个月以上后接受检查的；这些患者的闭塞性细支气管炎表现为相对无细胞的同心纤维化过程，仅限于终末细支气管。这3例患者的闭塞性细支气管炎被认为是慢性肺移植排斥反应的继发表现。7例患有闭塞性细支气管炎的患者中，有4例是在移植6个月以内接受检查的；这些患者的闭塞性细支气管炎是局灶性且有细胞浸润的。它延伸至远端肺泡腔，在一些病例中，还与吸入物质及异物型巨细胞有关。这4例患者均同时存在感染、误吸或大气道阻塞，这些被认为是导致闭塞性细支气管炎发生的原因。肺移植受者的闭塞性细支气管炎可能有多种病因，在特定病例中，这一过程的病因通常可通过该病变的形态学表现推断出来。
