Yamanashi Keiji, Chen-Yoshikawa Toyofumi Fengshi, Hamaji Masatsugu, Yurugi Kimiko, Tanaka Satona, Yutaka Yojiro, Yamada Yoshito, Nakajima Daisuke, Ohsumi Akihiro, Date Hiroshi
Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Transfusion Medicine and Cell Therapy, Kyoto University, Kyoto, Japan.
Gen Thorac Cardiovasc Surg. 2020 Feb;68(2):142-149. doi: 10.1007/s11748-019-01189-1. Epub 2019 Aug 21.
This study assessed the outcomes of combination therapy including rituximab for antibody-mediated rejection after lung transplantation.
Retrospective chart reviews were performed for all patients who received combination therapy including rituximab for post-lung transplantation antibody-mediated rejection between June 2008 and October 2018.
Among the 196 consecutive patients undergoing lung transplantation during the study period, eight (4.1%) were eligible for this study. Two patients (25.0%) were classified as having clinically definite antibody-mediated rejection and six (75.0%) as having possible antibody-mediated rejection. Prior to treatment, four patients (50.0%) met the definition of chronic lung allograft dysfunction; seven of the eight patients (87.5%) remained alive at 6 months and four (50.0%) at 12 months after antibody-mediated rejection. All patients identified as having chronic lung allograft dysfunction, prior to the treatment, died of allograft failure, or underwent re-transplantation. Decreases in the mean fluorescence intensities of the major donor-specific antibodies were observed in three patients. One patient, diagnosed with clinical antibody-mediated rejection but without pre-treatment chronic lung allograft dysfunction, began treatment relatively soon after lung transplantation, and demonstrated improved respiratory function at the 3-year follow-up.
Our experience suggests that multimodality therapy that includes rituximab is feasible and may prevent progression of antibody-mediated rejection after lung transplantation in selected patients.
本研究评估了包括利妥昔单抗在内的联合治疗对肺移植后抗体介导排斥反应的疗效。
对2008年6月至2018年10月期间接受包括利妥昔单抗在内的联合治疗以应对肺移植后抗体介导排斥反应的所有患者进行回顾性病历审查。
在研究期间连续接受肺移植的196例患者中，有8例（4.1%）符合本研究条件。2例患者（25.0%）被归类为临床确诊的抗体介导排斥反应，6例（75.0%）为可能的抗体介导排斥反应。治疗前，4例患者（50.0%）符合慢性肺移植功能障碍的定义；8例患者中有7例（87.5%）在抗体介导排斥反应后6个月时存活，4例（50.0%）在12个月时存活。所有在治疗前被确定为患有慢性肺移植功能障碍的患者均死于移植失败或接受了再次移植。3例患者的主要供体特异性抗体平均荧光强度降低。1例被诊断为临床抗体介导排斥反应但治疗前无慢性肺移植功能障碍的患者在肺移植后相对较早开始治疗，并在3年随访时显示呼吸功能改善。
我们的经验表明，包括利妥昔单抗在内的多模式治疗是可行的，并且可能防止选定患者肺移植后抗体介导排斥反应的进展。
