Pulmonary, Allergy, and Critical Care Division, Department of Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Am J Transplant. 2011 Nov;11(11):2517-22. doi: 10.1111/j.1600-6143.2011.03702.x. Epub 2011 Aug 22.
Primary graft dysfunction (PGD) after lung transplantation may result from ischemia reperfusion injury (IRI). The innate immune response to IRI may be mediated by Toll-like receptor and IL-1-induced long pentraxin-3 (PTX3) release. We hypothesized that elevated PTX3 levels were associated with PGD. We performed a nested case control study of lung transplant recipients with idiopathic pulmonary fibrosis (IPF) or chronic obstructive pulmonary disease (COPD) from the Lung Transplant Outcomes Group cohort. PTX3 levels were measured pretransplant, and 6 and 24 h postreperfusion. Cases were subjects with grade 3 PGD within 72 h of transplantation and controls were those without grade 3 PGD. Generalized estimating equations and multivariable logistic regression were used for analysis. We selected 40 PGD cases and 79 non-PGD controls. Plasma PTX3 level was associated with PGD in IPF but not COPD recipients (p for interaction < 0.03). Among patients with IPF, PTX3 levels at 6 and 24 h were associated with PGD (OR = 1.6, p = 0.02 at 6 h; OR = 1.4, p = 0.008 at 24 h). Elevated PTX3 levels were associated with the development of PGD after lung transplantation in IPF patients. Future studies evaluating the role of innate immune activation in IPF and PGD are warranted.
原发性移植物功能障碍（PGD）可能是由于肺移植后的缺血再灌注损伤（IRI）引起的。IRI 的固有免疫反应可能是由 Toll 样受体和 IL-1 诱导的长五聚蛋白-3（PTX3）释放介导的。我们假设升高的 PTX3 水平与 PGD 有关。我们对来自肺移植结果组队列的特发性肺纤维化（IPF）或慢性阻塞性肺疾病（COPD）的肺移植受者进行了一项嵌套病例对照研究。PTX3 水平在移植前、再灌注后 6 小时和 24 小时测量。病例是移植后 72 小时内出现 3 级 PGD 的患者，对照是没有 3 级 PGD 的患者。使用广义估计方程和多变量逻辑回归进行分析。我们选择了 40 例 PGD 病例和 79 例非 PGD 对照。在 IPF 而不是 COPD 受者中，血浆 PTX3 水平与 PGD 相关（交互作用的 p 值<0.03）。在 IPF 患者中，6 小时和 24 小时的 PTX3 水平与 PGD 相关（OR=1.6，p=0.02 在 6 小时；OR=1.4，p=0.008 在 24 小时）。PTX3 水平升高与 IPF 患者肺移植后 PGD 的发生有关。需要进一步的研究来评估固有免疫激活在 IPF 和 PGD 中的作用。
