Keenan R J, Zeevi A
Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA.
Chest Surg Clin N Am. 1995 Feb;5(1):107-20.
With current immunosuppressive regimens, rejection is common after lung transplantation. Acute rejection is usually easily reversible with therapy, but chronic rejection often responds poorly and is the leading cause of late morbidity and mortality. Although the pathogenesis of chronic rejection is not fully understood and might be different from ACR, the studies summarized in this review support the concept that alloimmune responses are of fundamental importance. Acute rejection and infection, particularly with CMV, appear to promote changes within the allograft that increase the risk of chronic rejection. Although the progression of OB in some patients might be arrested with immunosuppression, a large percentage of patients with OB suffer from a continuous loss of lung function. Improvement in the long-term outcome of lung transplant recipients will require both better immunosuppressive agent and more specific therapy such as induction of donor-specific tolerance.
在当前的免疫抑制方案下，肺移植后排斥反应很常见。急性排斥反应通常通过治疗很容易逆转，但慢性排斥反应往往反应不佳，是晚期发病和死亡的主要原因。尽管慢性排斥反应的发病机制尚未完全了解，可能与急性细胞排斥反应不同，但本综述总结的研究支持同种免疫反应至关重要这一概念。急性排斥反应和感染，尤其是巨细胞病毒感染，似乎会促进移植肺内的变化，增加慢性排斥反应的风险。尽管部分患者的闭塞性细支气管炎进展可能会因免疫抑制而停止，但很大一部分闭塞性细支气管炎患者的肺功能会持续丧失。改善肺移植受者的长期预后既需要更好的免疫抑制剂，也需要更具特异性的治疗方法，如诱导供体特异性耐受。
