Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan.
Front Immunol. 2021 Feb 22;12:630051. doi: 10.3389/fimmu.2021.630051. eCollection 2021.
Little evidence has been presented about the association between previous atopic/allergic disease and graft rejection after solid organ transplantation. Thus, we present a case wherein acute cellular rejection (ACR) after heart transplantation (HTx) was noted along with exacerbation of atopic disease.
A 32-year-old man was admitted at our hospital for regular monitoring of graft rejection. He had undergone heart transplant 3 years prior due to dilated cardiomyopathy. Echocardiogram revealed good biventricular function, and no abnormal findings were found in blood sampling tests. However, biopsy showed moderate ACR [Grade 2R(ISHLT 2004)/3A(ISHLT 1990)], which required twice-repeated steroid pulses with intensified immunosuppression. Meanwhile, his atopic dermatitis, which was diagnosed before having heart failure, was getting worse for the past 6 months. The exacerbation of atopic dermatitis was presumed to be related to the development of the intractable cellular rejection.
This case suggested the association of atopic disease and graft rejection after HTx. We examined 76 patients from a cohort of previous studies who underwent HTx at our hospital, which suggested that patients with atopic/allergic disorders such as atopic dermatitis and asthma tended to have a significantly higher frequency of moderate rejection than non-allergic patients. (p = 0.012; Fisher's exact test). Our case also suggests that exacerbation of atopic dermatitis might cause graft rejection of the transplanted organ, so that it is important to carefully evaluate the risk of graft rejection if there is a previous history of atopic/allergic disease.
鲜有证据表明既往特应性/过敏性疾病与实体器官移植后移植物排斥反应之间存在关联。因此，我们报告了一例心脏移植（HTx）后发生急性细胞排斥反应（ACR）的病例，同时特应性疾病也加重了。
一名 32 岁男性因扩张型心肌病在我院接受常规移植物排斥监测。他在 3 年前接受了心脏移植。超声心动图显示双心室功能良好，血液采样检查未发现异常。然而，活检显示中度 ACR[ISHLT 2004 分级 2R/3A（ISHLT 1990）]，需要两次重复类固醇冲击和强化免疫抑制。与此同时，他在心力衰竭之前被诊断出的特应性皮炎在过去 6 个月里越来越严重。特应性皮炎的恶化被认为与难治性细胞排斥反应的发展有关。
该病例提示特应性疾病与 HTx 后移植物排斥反应有关。我们检查了我院既往 HTx 队列中的 76 名患者，结果表明，特应性皮炎和哮喘等特应性/过敏性疾病患者的中度排斥反应频率显著高于非过敏性患者（p=0.012；Fisher 确切检验）。我们的病例还提示特应性皮炎的恶化可能导致移植器官的排斥反应，因此，如果有特应性/过敏性疾病的既往史，仔细评估移植物排斥反应的风险很重要。
