Higenbottam T, Hutter J A, Stewart S, Wallwork J
Department of Surgery, Papworth Hospital, Cambridge, England.
J Heart Transplant. 1988 Nov-Dec;7(6):435-9.
Between April 1984 and August 1987, 27 patients have received heart-lung transplantations at Papworth Hospital. In the first 17 patients endomyocardial biopsies were performed routinely in accordance with the practice for heart transplant recipients. It became apparent that in contrast to heart transplant recipients, heart-lung transplant recipients show little evidence of cardiac rejection. As routine endomyocardial biopsies did not contribute therefore to patient management, they were stopped. Conversely, pulmonary rejection was diagnosed either clinically by a decrease in forced expired volume in 1 second (FEV1) in the absence of lung infection or by transbronchial biopsy, which determined when immunosuppression needed to be augmented. The presence of lung rejection was confirmed by resolution of the lung histopathology or improvement in FEV1.
1984年4月至1987年8月期间，27例患者在帕普沃思医院接受了心肺移植手术。前17例患者按照心脏移植受者的常规做法进行了心内膜心肌活检。结果发现，与心脏移植受者不同，心肺移植受者几乎没有心脏排斥反应的迹象。因此，由于常规心内膜心肌活检对患者管理没有帮助，便停止了这项检查。相反，肺部排斥反应可通过在无肺部感染情况下一秒用力呼气量（FEV1）下降进行临床诊断，或通过经支气管活检来诊断，经支气管活检可确定何时需要加强免疫抑制。肺部组织病理学检查结果恢复正常或FEV1改善则证实存在肺部排斥反应。
