Department of Pathology, CHU Sart-Tilman, University of Liège, Belgium.
Pathol Res Pract. 2010 Jun 15;206(6):411-4. doi: 10.1016/j.prp.2009.10.010. Epub 2010 Jan 20.
We report the case of a patient with giant cell myocarditis who was bridged to transplantation with mechanical circulatory support and developed a fatal perioperative hyperacute rejection. The patient had received abundant transfusions that had raised her anti-HLA antibody titers. The cross-match test was positive. No pre-transplantation immunosuppressive therapy had been administered given concomitant infection. The severity and acuteness of the rejection in this case likely reflect the combined effect of preformed anti-HLA antibodies in the context of an active organ-specific immune process at the time of transplantation. This case raises the questions of the need for intensive immunosuppressive therapy before transplantation in giant cell myocarditis and of the management of patients with positive cross-match in the context of a giant cell myocarditis.
我们报告了一例巨细胞心肌炎患者，该患者在机械循环支持下进行了移植桥接，并发生了致命的围手术期超急性排斥反应。患者接受了大量输血，导致其 HLA 抗体滴度升高。交叉配型试验阳性。由于同时存在感染，因此未给予移植前免疫抑制治疗。这种排斥反应的严重程度和急性程度可能反映了在移植时活跃的器官特异性免疫过程中预先形成的抗 HLA 抗体的综合作用。该病例提出了在巨细胞心肌炎患者移植前是否需要强化免疫抑制治疗的问题，以及在巨细胞心肌炎患者中交叉配型阳性患者的管理问题。
