Keenan R J, Bruzzone P, Paradis I L, Yousem S A, Dauber J H, Stuart R S, Griffith B P
Department of Surgery, University of Pittsburgh, Pennsylvania 15261.
Transplantation. 1991 Jan;51(1):176-80. doi: 10.1097/00007890-199101000-00027.
The transbronchial biopsy and clinical courses of 9 double-lung and 1 single-lung recipients surviving greater than 10 days were analyzed and compared to those of 15 heart-lung transplants performed during the same time period. Of these, 8 isolated lung (LT) and 11 heart-lung transplant (HLT) recipients survived greater than 50 days and were at risk of developing obliterative bronchiolitis believed to be a form of chronic rejection. Cyclosporine-based immunosuppression, in combination with azathioprine and steroids, was used for 22 of 25 patients. Two double-lung recipients and 1 heart-lung patient received FK506 as the sole immunosuppressive agent; 90% and 62% of LT, and 67% and 54% of HLT recipients developed acute and chronic rejection, respectively (P = NS). The average time to first episode of acute (30.2 days [LT] versus 21.5 days [HLT]) and chronic rejection (146 days [LT] versus 193.7 days [HLT]) was not different between groups (P = NS). Age (34.2 [LT] versus 29.1 [HLT]) and sex (M:F, 5:5 [LT] versus 5:10 [HLT]) were also not found to be discriminators. The histologic diagnosis of chronic rejection was associated with significant declines in FEV1.0 and FEF25-75 (P less than 0.02). There was only one instance of cardiac rejection among the heart-lung transplant recipients. Heart-lung and isolated lung transplant patients appear to be at similar risk for developing acute or chronic pulmonary rejection.
分析并比较了9例双肺移植受者和1例单肺移植受者存活超过10天的经支气管活检及临床病程，并与同期进行的15例心肺移植受者的情况进行对比。其中，8例孤立肺移植（LT）受者和11例心肺移植（HLT）受者存活超过50天，有发生闭塞性细支气管炎的风险，闭塞性细支气管炎被认为是一种慢性排斥反应形式。25例患者中有22例使用了以环孢素为基础的免疫抑制方案，联合硫唑嘌呤和类固醇。2例双肺移植受者和1例心肺移植受者接受FK506作为唯一免疫抑制剂；LT受者中分别有90%和62%发生急性和慢性排斥反应，HLT受者中分别有67%和54%发生急性和慢性排斥反应（P=无显著性差异）。两组之间急性排斥反应首次发作的平均时间（LT为30.2天，HLT为21.5天）和慢性排斥反应首次发作的平均时间（LT为146天，HLT为193.7天）无差异（P=无显著性差异）。年龄（LT为34.2岁，HLT为29.1岁）和性别（男:女，LT为5:5，HLT为5:10）也未发现有鉴别意义。慢性排斥反应的组织学诊断与第一秒用力呼气容积（FEV1.0）和25%-75%用力呼气流量（FEF25-75）的显著下降相关（P<0.02）。心肺移植受者中仅出现1例心脏排斥反应。心肺移植和孤立肺移植患者发生急性或慢性肺部排斥反应的风险似乎相似。
