Verleden Geert M, Raghu Ganesh, Meyer Keith C, Glanville Allan R, Corris Paul
University Hospital Gasthuisberg, Lung Transplantation Unit, Leuven, Belgium.
University of Washington School of Medicine, Seattle, Washington.
J Heart Lung Transplant. 2014 Feb;33(2):127-33. doi: 10.1016/j.healun.2013.10.022. Epub 2013 Oct 24.
Although survival after lung transplantation has improved significantly during the last decade, chronic rejection is thought to be the major cause of late mortality. The physiologic hallmark of chronic rejection has been a persistent fall in forced expiratory volume in 1 second associated with an obstructive ventilatory defect, for which the term bronchiolitis obliterans syndrome (BOS) was defined to allow a uniformity of description and grading of severity throughout the world. Although BOS was generally thought to be irreversible, recent evidence suggests that some patients with BOS may respond to azithromycin with > 10% improvement in their forced expiratory volume in 1 second. In addition, a restrictive form of chronic rejection has recently been described that does not fit the strict definition of BOS as an obstructive defect. Hence, the term chronic lung allograft dysfunction (CLAD) has been introduced to cover all forms of graft dysfunction, but CLAD has yet to be defined. We propose a definition of CLAD and a flow chart that may facilitate recognition of the different phenotypes of CLAD that can complicate the clinical course of lung transplant recipients.
尽管在过去十年中肺移植后的生存率有了显著提高，但慢性排斥反应被认为是晚期死亡的主要原因。慢性排斥反应的生理标志是第一秒用力呼气容积持续下降，并伴有阻塞性通气功能障碍，为此定义了闭塞性细支气管炎综合征（BOS）这一术语，以便在全球范围内对其进行统一描述和严重程度分级。尽管一般认为BOS是不可逆的，但最近的证据表明，一些BOS患者可能对阿奇霉素有反应，其第一秒用力呼气容积改善超过10%。此外，最近还描述了一种限制性慢性排斥反应形式，它不符合BOS作为阻塞性缺陷的严格定义。因此，引入了慢性肺移植功能障碍（CLAD）这一术语来涵盖所有形式的移植功能障碍，但CLAD尚未得到定义。我们提出了CLAD的定义和一个流程图，这可能有助于识别CLAD的不同表型，这些表型可能会使肺移植受者的临床病程复杂化。
