Miyazaki T, Tagawa T, Yamasaki N, Tsuchiya T, Matsumoto K, Nagayasu T
Division of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Transplant Proc. 2013 Jan-Feb;45(1):356-9. doi: 10.1016/j.transproceed.2012.09.112.
Lung transplantation cases have immunosuppression maintained using a calcineurin inhibitor, anti-metabolites, and steroid.
We report 2 clinical cases in which anti-metabolites (mycophenolate mofetil) were successfully withdrawn after living donor lobar lung transplantation by monitoring immune function using the ImmuKnow® assay. In the first case, a 43-year-old woman underwent living donor lobar lung transplantation for pulmonary alveolar proteinosis. Two healthy relatives donated a lower lobe each. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroid. Six months posttransplantation, she developed invasive pulmonary aspergillosis. During anti-fungal treatment, we withdrew mycophenolate mofetil and tacrolimus trough levels were kept around 8 ng/mL. Despite the resulting low-level immunosuppression, the ImmuKnow assay showed immune function to be in the moderate range with tacrolimus and steroid alone, encouraging us to maintain this strategy to avoid recurrence of invasive pulmonary aspergillosis. In the second case, a 24-year-old man underwent living donor lobar lung transplantation for cystic fibrosis. Two healthy relatives donated a lower lobe each. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroid. Five months posttransplantation, he developed persistent Pseudomonas aeruginosa pneumonia derived from the paranasal sinuses. Under ImmuKnow assay monitoring, mycophenolate mofetil was withdrawn, but immune function was maintained within the moderate range using tacrolimus and steroid alone.
Respiratory function in both cases was maintained; no findings of bronchiolitis obliterans syndrome were noted during this period. To the best of our knowledge, no reports have described successful anti-metabolite withdrawal in lung transplantation with ImmuKnow monitoring. Immune evaluation by ImmuKnow could offer a useful method to monitor and control immune status, particularly among recipients susceptible to infection, revealing that moderate immune function could be maintained using tacrolimus and steroid in living donor lobar lung transplantation.
肺移植病例使用钙调神经磷酸酶抑制剂、抗代谢药物和类固醇维持免疫抑制。
我们报告了2例临床病例，在活体供体肺叶移植后，通过使用ImmuKnow®检测法监测免疫功能，成功停用了抗代谢药物（霉酚酸酯）。在第一例病例中，一名43岁女性因肺泡蛋白沉积症接受了活体供体肺叶移植。两名健康亲属各捐献了一个下叶。使用他克莫司、霉酚酸酯和类固醇维持免疫抑制。移植后6个月，她发生了侵袭性肺曲霉病。在抗真菌治疗期间，我们停用了霉酚酸酯，他克莫司谷浓度维持在8 ng/mL左右。尽管由此导致免疫抑制水平较低，但ImmuKnow检测显示，仅使用他克莫司和类固醇时免疫功能处于中等范围，这鼓励我们维持该策略以避免侵袭性肺曲霉病复发。在第二例病例中，一名24岁男性因囊性纤维化接受了活体供体肺叶移植。两名健康亲属各捐献了一个下叶。使用他克莫司、霉酚酸酯和类固醇维持免疫抑制。移植后5个月，他发生了源自鼻窦的持续性铜绿假单胞菌肺炎。在ImmuKnow检测监测下，停用了霉酚酸酯，但仅使用他克莫司和类固醇时免疫功能维持在中等范围。
两例病例的呼吸功能均得以维持；在此期间未发现闭塞性细支气管炎综合征的迹象。据我们所知，尚无报告描述在ImmuKnow监测下肺移植成功停用抗代谢药物的情况。通过ImmuKnow进行免疫评估可为监测和控制免疫状态提供一种有用的方法，尤其是在易感染的受者中，这表明在活体供体肺叶移植中仅使用他克莫司和类固醇可维持中等免疫功能。
