Division of Pulmonary & Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
Curr Opin Organ Transplant. 2009 Oct;14(5):477-82. doi: 10.1097/MOT.0b013e32832fb981.
Rejection remains a common complication after lung transplantation and has adversely affected long-term outcomes. This manuscript reviews the various manifestations of rejection after lung transplantation and provides an update of recent developments.
The grading scheme for lymphocytic bronchiolitis was updated in 2007, and recent studies demonstrate that this disease is an important and independent risk factor for chronic rejection. Furthermore, a role for humoral immunity has become more apparent in recent years, although this role remains enigmatic in lung transplantation. Finally, a new subtype of bronchiolitis obliterans syndrome, termed neutrophilic reversible allograft dysfunction, has been proposed based on the response to treatment with azithromycin.
Acute rejection and lymphocytic bronchiolitis are major risk factors for chronic rejection, which remains the primary obstacle to better outcomes after lung transplantation.
肺移植后排斥仍是常见并发症，对长期预后产生不良影响。本文综述肺移植后排斥的各种表现，并介绍其最新进展。
2007 年更新了淋巴细胞性细支气管炎的分级方案，近期研究表明该病是慢性排斥的重要且独立的危险因素。此外，近年来体液免疫的作用更加明显，尽管在肺移植中其作用仍不明确。最后，根据阿奇霉素治疗的反应，提出了一种新的闭塞性细支气管炎综合征亚型，称为中性粒细胞可逆性同种异体移植功能障碍。
急性排斥和淋巴细胞性细支气管炎是慢性排斥的主要危险因素，慢性排斥仍是肺移植后改善预后的主要障碍。
