Trulock E P
Department of Medicine, Washington University School of Medicine, St. Louis.
Chest. 1993 May;103(5):1566-76. doi: 10.1378/chest.103.5.1566.
Using current immunosuppressive protocols, rejection is common after lung transplantation. Most recipients have at least one episode of acute rejection, and approximately 25 percent of recent long-term survivors have developed chronic rejection. Acute rejection has usually been reversible with treatment, but chronic rejection has responded poorly, relapsed frequently, and been one of the leading causes of late morbidity and mortality. Appropriate management of rejection is predicated on timely, accurate diagnosis. Clinical criteria for the diagnosis of acute rejection are useful but nonspecific, and TBB has emerged as the procedure of choice for diagnosing acute rejection and infection. Chronic rejection is manifested by OB and is characterized physiologically by the development of airflow obstruction. Although histologic confirmation is preferable, the sensitivity of TBB for the detection of OB has been inconsistent, and the specificity has been low. Lung transplantation has indeed come of age, but understanding the immunopathogenesis and improving the clinical management of rejection remain major challenges for the next decade.
采用当前的免疫抑制方案，肺移植后排斥反应很常见。大多数受者至少有一次急性排斥反应发作，近期长期存活者中约25%已发生慢性排斥反应。急性排斥反应通常经治疗后可逆转，但慢性排斥反应反应不佳、频繁复发，并且是晚期发病和死亡的主要原因之一。排斥反应的恰当管理取决于及时、准确的诊断。急性排斥反应诊断的临床标准有用但不具特异性，经支气管镜肺活检（TBB）已成为诊断急性排斥反应和感染的首选方法。慢性排斥反应以闭塞性细支气管炎（OB）为表现，生理特征为气流阻塞的发展。虽然组织学确诊更佳，但TBB检测OB的敏感性一直不一致，特异性也很低。肺移植确实已走向成熟，但了解免疫发病机制和改善排斥反应的临床管理在未来十年仍是重大挑战。
