Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School, Houston, TX 77030, USA.
Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
Ann Diagn Pathol. 2021 Dec;55:151832. doi: 10.1016/j.anndiagpath.2021.151832. Epub 2021 Sep 30.
Granulomatous infections are common in patients with chronic lung disease. We aim to study the incidence and clinicopathological features of granulomatous infections in a cohort of patients undergoing lung transplantation for end-stage chronic lung disease.
Pathology reports of 50 explanted native lungs of patients who underwent lung transplantation since 2015 at our institution were reviewed. Four cases with granulomatous lesions were identified. Correlation was made with clinical findings in the 4 cases.
The granulomatous infections include non-necrotizing cryptococcal pneumonitis (case 1), necrotizing pneumonia due to Scedosporium sp. and Mycobacterium avium Complex (MAC) (Cases 2 and 3), and invasive Aspergillus pneumonia (Case 4). One patient received pre-transplant fungal prophylaxis (Case 4). Post-transplant infectious complications included invasive (Cases 2 and 4) and non-invasive (Case 1) fungal infections and bacterial pneumonia (Cases 1 and 2). Two patients (Cases 3 and 4) developed acute cellular rejection (ACR) in the first 30 days. The third patient (Case 1) was identified with ACR in the 9 months post-transplant and chronic lung allograft dysfunction at 29 months. In terms of mortality, 1 patient (Case 1) died at 30 months post-transplant from pseudomonal sepsis and chronic graft failure. Two patients with invasive fungal infections (Cases 2 and 4) are on secondary prophylaxis and doing well. One patient (Case 3) remains infection-free and on MAC prophylaxis.
In our case series, patients with chronic lung diseases with superimposed granulomatous infestations frequently experienced post-transplant complications. These include invasive infections and repeat ACRs that predispose patients to chronic graft dysfunction. Pre- and post-transplant antifungal prophylaxis reduces fungal load and complication risk post-transplant.
慢性肺部疾病患者常发生肉芽肿性感染。我们旨在研究一组因终末期慢性肺部疾病行肺移植的患者中肉芽肿性感染的发病率和临床病理特征。
回顾了我院自 2015 年以来接受肺移植的 50 例患者的移植肺病理报告。发现 4 例存在肉芽肿性病变。对这 4 例患者的临床发现进行了相关性分析。
这 4 例患者的肉芽肿性感染包括非坏死性隐球菌性肺炎（病例 1）、由 Scedosporium sp.和 MAC 引起的坏死性肺炎（病例 2 和 3），以及侵袭性曲霉病肺炎（病例 4）。其中 1 例患者接受了移植前真菌预防治疗（病例 4）。移植后的感染并发症包括侵袭性（病例 2 和 4）和非侵袭性（病例 1）真菌感染和细菌性肺炎（病例 1 和 2）。2 例患者（病例 3 和 4）在移植后 30 天内发生急性细胞排斥反应（ACR）。第 3 例患者（病例 1）在移植后 9 个月时被诊断为 ACR，29 个月时出现慢性肺移植物功能障碍。在死亡率方面，1 例患者（病例 1）在移植后 30 个月因假单胞菌败血症和慢性移植物衰竭而死亡。2 例侵袭性真菌感染患者（病例 2 和 4）正在接受二线预防治疗，情况良好。1 例患者（病例 3）无感染且正在接受 MAC 预防治疗。
在我们的病例系列中，患有慢性肺部疾病且合并肉芽肿性感染的患者经常出现移植后并发症。这些并发症包括侵袭性感染和反复 ACR，使患者易发生慢性移植物功能障碍。移植前和移植后抗真菌预防可减少移植后真菌负荷和并发症风险。
