Griffith B P, Paradis I L, Zeevi A, Rabinowich H, Yousem S A, Duquesnoy R J, Dauber J H, Hardesty R L
Department of Surgery, University of Pittsburgh School of Medicine, PA 15261.
Ann Surg. 1988 Sep;208(3):371-8. doi: 10.1097/00000658-198809000-00015.
Obliterative bronchiolitis has occurred in eleven of 30 recipients of cardiopulmonary allografts who survived at least 4 months after transplantation, has caused significant morbidity, and has been associated with four of eleven late deaths in this series. Although some improvement, or at least stability, of pulmonary function has followed augmented immune suppression, it appears that once the process is recognized clinically, much of the damage to the airways is irreversible. The histopathology, response to therapy, and, most important, the response of donor specific alloreactivity in the lymphocytes from the lung (bronchoalveolar lavage and peripheral blood) suggest immune- mediated basis for bronchiolitis obliterans. The presence of donor specific alloreactivity detected by primed lymphocyte testing predicted obliterative bronchiolitis in five of six recipients (83% sensitivity, 91% specificity) was absent in ten of eleven recipients who have not as yet developed the process (negative predicted value of 91%). Currently, the presence of a positive primed lymphocyte test in the bronchoalveolar lavage of the cardiopulmonary recipient is an indication for early treatment by augmented immune suppression.
在30例心肺移植受者中，有11例在移植后存活至少4个月时发生了闭塞性细支气管炎，该疾病已导致显著的发病率，并且在本系列中11例晚期死亡中有4例与之相关。尽管强化免疫抑制后肺功能有了一些改善，或至少保持稳定，但一旦在临床上识别出该过程，气道的许多损伤似乎是不可逆的。组织病理学、对治疗的反应，以及最重要的是来自肺（支气管肺泡灌洗和外周血）的淋巴细胞中供体特异性同种异体反应性的反应，提示闭塞性细支气管炎存在免疫介导的基础。通过致敏淋巴细胞试验检测到的供体特异性同种异体反应性的存在，在6例受者中有5例预测了闭塞性细支气管炎（敏感性83%，特异性91%），在11例尚未发生该过程的受者中有10例不存在（阴性预测值91%）。目前，心肺移植受者支气管肺泡灌洗中致敏淋巴细胞试验呈阳性是强化免疫抑制早期治疗的指征。
