Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, TO, Ontario, Canada.
Transpl Infect Dis. 2020 Jun;22(3):e13262. doi: 10.1111/tid.13262. Epub 2020 Feb 26.
The significance of granuloma in explanted lungs of lung transplant recipients (LTR) on the development of post-transplant mycobacterial infection is unclear.
A retrospective review comparing LTRs and heart-lung transplant (H-LTR) recipients with granuloma in the explanted lungs between 2000 and 2012 (excluding those LTRs with granuloma due to sarcoidosis) and LTRs or H-LTRs without granuloma. Patients were followed for 2 years post-transplant.
A total of 144 LTRs and 4 H-LTRs with granulomas (75 necrotizing and 73 non-necrotizing) and a comparator cohort of 144 LTRs and 4 H-LTRs without granuloma were analyzed. In LTRs with granulomas, identification of infectious organisms was more common by histopathology (35 AFB and 22 fungal) compared to cultures (six NTM and seven fungal) taken around time of the transplant. LTRs with granulomas were more likely to have pre-transplant non-tuberculous mycobacteria (NTM) infection compared to LTRs without granuloma; P < .01. In the multivariate analysis, having granuloma or positive mycobacterial cultures at time of transplant were associated with increased risk of post-transplant mycobacterial infection (HR = 1.8 95% CI [1.024-3.154]; P = .041 and HR = 2.083 95% CI [1.011-4.292]; P = .047). Although there was a trend toward increase mycobacterial disease in those with granulomas P = .056, there was no difference in survival post-transplantation between those with or without granuloma in the explanted lung; P = .886.
The presence of granuloma in the explanted lungs of LTRs or positive mycobacterial cultures at time of transplant is associated with an increased risk of mycobacterial infection post-transplant.
在移植肺中，移植受体（LTR）的肉芽肿对移植后分枝杆菌感染的发展意义尚不清楚。
回顾性比较 2000 年至 2012 年间移植肺中存在肉芽肿的 LTR 和心肺移植（H-LTR）受体（不包括因结节病而存在肉芽肿的 LTR）与移植肺中不存在肉芽肿的 LTR 或 H-LTR。对患者进行了 2 年的移植后随访。
共分析了 144 例 LTR 和 4 例 H-LTR 有肉芽肿（75 例坏死性和 73 例非坏死性）以及对照组的 144 例 LTR 和 4 例 H-LTR 无肉芽肿。在有肉芽肿的 LTR 中，组织病理学检查比培养物（移植时采集的六株 NTM 和七株真菌）更常发现感染病原体（35 株 AFB 和 22 株真菌）。与无肉芽肿的 LTR 相比，有肉芽肿的 LTR 更有可能在移植前患有非结核分枝杆菌（NTM）感染；P <.01。在多变量分析中，移植时存在肉芽肿或分枝杆菌培养阳性与移植后分枝杆菌感染的风险增加相关（HR=1.8，95%CI[1.024-3.154]；P=0.041 和 HR=2.083，95%CI[1.011-4.292]；P=0.047）。尽管有趋势表明，在有肉芽肿的患者中，分枝杆菌病的发生率增加（P=0.056），但在移植肺中有无肉芽肿的患者之间，移植后的存活率没有差异；P=0.886。
LTR 移植肺中存在肉芽肿或移植时分枝杆菌培养阳性与移植后分枝杆菌感染的风险增加相关。
