Johnson B A, Duncan S R, Ohori N P, Paradis I L, Yousem S A, Grgurich W F, Dauber J H, Griffith B P
Department of Medicine, University of Pittsburgh, Pennsylvania.
Am Rev Respir Dis. 1993 Nov;148(5):1373-7. doi: 10.1164/ajrccm/148.5.1373.
Lung transplantation is a potentially curative therapy for the end-stage pulmonary sequelae of sarcoidosis. We reviewed the course of five lung allograft recipients with underlying sarcoidosis (S) at the University of Pittsburgh Medical Center and compared them with a control group (C) of 44 contemporaneous transplant recipients with other respiratory diseases. Sarcoid granulomata have developed in the allografts of 4 S, although these lesions have not yet been demonstrated to result in clinically significant abnormalities. In comparison with C, sarcoidosis patients had significantly greater mean grades of acute rejection during the first 3 months after transplantation (2.1 +/- 0.3 versus 1.6 +/- 0.1, S and C, respectively, p < 0.042) and larger proportions of lung biopsies showing more than mild acute rejection (40 versus 18%, p < 0.012) and lymphocytic bronchitis (30 versus 13%, p = 0.02), as well as a greater percentage of polymorphonuclear leukocytes in BAL returns (34.9 +/- 5.4 versus 19.0 +/- 1.6, p < 0.01). The two groups did not differ, however, in frequency of obliterative bronchiolitis, survival, or pulmonary function. We conclude that lung transplant recipients with underlying sarcoidosis are very likely to develop recurrent disease in the allograft and have more severe acute rejection responses, especially in the first weeks after transplantation. Pulmonary transplantation appears to be an efficacious therapy for end-stage sarcoidosis, but the long-term sequelae of the increased acute rejection and recurrent sarcoidosis in the allograft remain to be determined.
肺移植是结节病终末期肺部后遗症的一种潜在治愈性疗法。我们回顾了匹兹堡大学医学中心5例患有潜在结节病（S）的肺移植受者的病程，并将他们与44例同期患有其他呼吸系统疾病的移植受者组成的对照组（C）进行比较。4例S患者的移植肺中出现了结节性肉芽肿，尽管这些病变尚未被证明会导致具有临床意义的异常。与C组相比，结节病患者在移植后的前3个月急性排斥反应的平均分级明显更高（S组和C组分别为2.1±0.3和1.6±0.1，p<0.042），且肺活检显示急性排斥反应超过轻度的比例更高（40%对18%，p<0.012），淋巴细胞性支气管炎的比例也更高（30%对13%，p = 0.02），同时支气管肺泡灌洗回收液中多形核白细胞的百分比更高（34.9±5.4对19.0±1.6，p<0.01）。然而，两组在闭塞性细支气管炎的发生率、生存率或肺功能方面没有差异。我们得出结论，患有潜在结节病的肺移植受者很可能在移植肺中出现疾病复发，并且有更严重的急性排斥反应，尤其是在移植后的头几周。肺移植似乎是终末期结节病的一种有效疗法，但移植肺中急性排斥反应增加和结节病复发的长期后果仍有待确定。
