Levêque Manon, Cassir Nadim, Mathias Fanny, Fevre Cindy, Daviet Florence, Bermudez Julien, Brioude Geoffrey, Peyron Florence, Reynaud-Gaubert Martine, Coiffard Benjamin
Department of Respiratory Medicine and Lung Transplantation, APHM, Aix Marseille University, Hôpital Nord, Marseille, France.
Department of Infectious Disease, APHM, IHU Méditerranée Infection, Aix-Marseille University, Marseille, France.
Infect Drug Resist. 2023 Jun 30;16:4265-4271. doi: 10.2147/IDR.S413900. eCollection 2023.
Recipients transplanted for bronchiectasis in the context of a primary immune deficiency, such as common variable immunodeficiency, are at a high risk of severe infection in post-transplantation leading to poorer long-term outcomes than other transplant indications. In this report, we present a fatal case due to chronic bronchopulmonary infection in a lung transplant recipient with common variable immunodeficiency despite successful eradication of an extensively drug-resistant (XDR) strain with IgM/IgA-enriched immunoglobulins and bacteriophage therapy. The fatal evolution despite a drastic adaptation of the immunosuppressive regimen and the maximal antibiotic therapy strategy raises the question of the contraindication of lung transplantation in such a context of primary immunodeficiency.
在原发性免疫缺陷（如常见变异型免疫缺陷）背景下因支气管扩张症接受移植的受者，在移植后发生严重感染的风险很高，导致其长期预后比其他移植指征更差。在本报告中，我们介绍了一例因慢性支气管肺部感染导致死亡的病例，该病例为一名患有常见变异型免疫缺陷的肺移植受者，尽管使用富含IgM/IgA的免疫球蛋白和噬菌体疗法成功根除了一株广泛耐药（XDR）菌株。尽管对免疫抑制方案进行了大幅调整并采取了最大程度的抗生素治疗策略，但仍出现了致命的病情进展，这引发了在这种原发性免疫缺陷背景下肺移植禁忌问题的思考。
