Benden Christian, Speich Rudolf, Hofbauer Günther F, Irani Sarosh, Eich-Wanger Christine, Russi Erich W, Weder Walter, Boehler Annette
Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
Transplantation. 2008 Dec 15;86(11):1625-7. doi: 10.1097/TP.0b013e31818bc024.
We report the largest single-center experience with extracorporeal photopheresis (ECP) for bronchiolitis obliterans syndrome (BOS) and recurrent acute rejection (AR) after lung transplantation. Lung transplant recipients undergoing ECP for BOS and recurrent AR were included (1997-2007). The rate of forced expiratory volume in 1 second (FEV1) decline was used as the primary measure and graft survival post-ECP as the secondary measure of efficacy. Twenty-four transplant recipients were included (BOS, n=12; recurrent AR, n=12). In recipients with BOS, decline in FEV1 was 112 mL/month before the start of ECP and 12 mL/month after 12 ECP cycles (P=0.011), mean (95% CI) change in rate of decline was 100 (28-171). Median patient survival was 7.0 (range, 3.0-13.6) years, median patient survival post-ECP 4.9 (range, 0.5-8.4) years. No ECP-related complications occurred. Extracorporeal photopheresis reduces the rate of lung function decline in recipients with BOS and is well tolerated. Furthermore, recipients with recurrent AR experience clinical stabilization. However, the underlying mechanism of ECP remains subject to further research.
我们报告了体外光化学疗法（ECP）治疗闭塞性细支气管炎综合征（BOS）及肺移植后反复急性排斥反应（AR）的最大单中心经验。纳入了因BOS和反复AR接受ECP治疗的肺移植受者（1997年至2007年）。将一秒用力呼气容积（FEV1）下降率作为主要疗效指标，将ECP治疗后的移植物存活情况作为次要疗效指标。共纳入24例移植受者（BOS患者12例；反复AR患者12例）。在BOS患者中，ECP开始前FEV1每月下降112 mL，12个ECP周期后每月下降12 mL（P = 0.011），下降率的平均（95%CI）变化为100（28 - 171）。患者中位生存期为7.0（范围3.0 - 13.6）年，ECP治疗后患者中位生存期为4.9（范围0.5 - 8.4）年。未发生与ECP相关的并发症。体外光化学疗法可降低BOS患者的肺功能下降率，且耐受性良好。此外，反复AR患者病情实现临床稳定。然而，ECP的潜在机制仍有待进一步研究。
