January Spenser E, Fester Keith A, Bain Karen Bennett, Kulkarni Hrishikesh S, Witt Chad A, Byers Derek E, Alexander-Brett Jennifer, Trulock Elbert P, Hachem Ramsey R
Department of Pharmacy, Barnes-Jewish Hospital, Saint Louis, Missouri.
Division of Pulmonary and Critical Care, Washington University Physicians, Saint Louis, Missouri.
Clin Transplant. 2019 Oct;33(10):e13708. doi: 10.1111/ctr.13708. Epub 2019 Sep 17.
Chronic lung allograft dysfunction (CLAD) is the leading cause of death beyond the first year after lung transplantation. Several treatments have been used to prevent the progression or reverse the effects of CLAD. Cytolytic therapy with rabbit antithymocyte globulin (rATG) has previously shown to be a potential option. However, the effect on patients with restrictive allograft syndrome (RAS) versus bronchiolitis obliterans syndrome (BOS) and the effect of cumulative dosing are unknown.
The charts of lung transplant patients treated with rATG at Barnes-Jewish Hospital from 2009 to 2016 were retrospectively reviewed. The primary outcome was response to rATG; patients were deemed responders if their FEV improved in the 6 months after rATG treatment. Safety endpoints included incidence of serum sickness, cytokine release syndrome, malignancy, and infectious complications.
108 patients were included in this study; 43 (40%) patients were responders who experienced an increase in FEV after rATG therapy. No predictors of response to rATG therapy were identified. Serum sickness occurred in 22% of patients, 15% experienced cytokine release syndrome, and 19% developed an infection after therapy.
40% of patients with CLAD have an improvement in lung function after treatment with rATG although the improvement was typically minimal.
慢性肺移植功能障碍（CLAD）是肺移植术后第一年以后死亡的主要原因。已经采用了几种治疗方法来预防CLAD的进展或逆转其影响。先前已证明用兔抗胸腺细胞球蛋白（rATG）进行细胞溶解疗法是一种潜在的选择。然而，其对限制性移植综合征（RAS）患者与闭塞性细支气管炎综合征（BOS）患者的疗效以及累积给药的效果尚不清楚。
回顾性分析2009年至2016年在巴恩斯犹太医院接受rATG治疗的肺移植患者的病历。主要结局是对rATG的反应；如果患者在rATG治疗后的6个月内FEV有所改善，则被视为有反应者。安全终点包括血清病、细胞因子释放综合征、恶性肿瘤和感染并发症的发生率。
本研究纳入了108例患者；43例（40%）患者有反应，在rATG治疗后FEV增加。未发现rATG治疗反应的预测因素。22%的患者发生血清病，15%经历细胞因子释放综合征，19%在治疗后发生感染。
40%的CLAD患者在接受rATG治疗后肺功能有所改善，尽管改善通常很小。
