Kesten S, Chamberlain D, Maurer J
Department of Medicine, Toronto Hospital, Ontario, Canada.
J Heart Lung Transplant. 1996 Apr;15(4):384-8.
Acute lung rejection after transplantation may lead to significant graft dysfunction. Hence surveillance protocols which include transbronchial biopsies have been established to monitor for early findings suggestive of acute rejection. However, the frequency of acute rejection diminishes as time from the transplant procedure increases. We therefore sought to examine the incidence of acute rejection seen on surveillance transbronchial biopsy performed at least 2 years after transplantation.
A retrospective review of all transbronchial biopsy was conducted. Forced expiratory volume in 1 second at the time of transbronchial biopsy and in the preceding 6 months was recorded.
A total of 102 transbronchial biopsy procedures were assessed. Histologic evidence of at least grade 2 rejection (including three judged as grade 1 to 2) occurred in biopsy samples from 10 procedures (9.8%). Five of the episodes occurred at 2 years, three occurred at 3 years, and two occurred at 4 years. Inadequate biopsies occurred on 22 occasions (21.6%). A corresponding significant change in forced expiratory volume in 1 second ( >or= 10% decline) compared with the preceding 6 months was seen in 4 of 10 episodes of grade 2 acute rejection. Only one of five episodes occurring at least 3 years after transplantation was associated with a decline in forced expiratory volume in 1 second. No evidence of acute rejection was found in any of 15 transbronchial biopsy procedures beyond 4 years after transplantation where adequate material for histologic interpretation was obtained. However, no statistically significant change was found in the proportion of transbronchial biopsy procedures showing acute rejection as a function of time.
We conclude that transbronchial biopsy-proven acute rejection may occur in patients with asymptomatic, stable conditions who have survived at least 2 years, but the yield of transbronchial biopsy performed beyond 4 years is exceedingly low.
移植后急性肺排斥反应可能导致严重的移植物功能障碍。因此，已制定了包括经支气管活检在内的监测方案，以监测提示急性排斥反应的早期发现。然而，随着移植手术时间的增加，急性排斥反应的发生率会降低。因此，我们试图研究移植后至少2年进行的监测性经支气管活检中急性排斥反应的发生率。
对所有经支气管活检进行回顾性分析。记录经支气管活检时及前6个月的1秒用力呼气量。
共评估了102例经支气管活检操作。10例（9.8%）活检样本出现至少2级排斥反应的组织学证据（包括3例判定为1至2级）。其中5例发生在2年时，3例发生在3年时，2例发生在4年时。22次（21.6%）活检样本不足。10例2级急性排斥反应中有4例与前6个月相比1秒用力呼气量有相应的显著变化（下降≥10%）。移植后至少3年发生的5例中只有1例与1秒用力呼气量下降有关。在移植后4年以上获得足够组织学解释材料的15例经支气管活检操作中，未发现急性排斥反应的证据。然而，显示急性排斥反应的经支气管活检操作比例随时间变化无统计学显著差异。
我们得出结论，经支气管活检证实的急性排斥反应可能发生在存活至少2年的无症状、病情稳定的患者中，但4年以上进行经支气管活检的阳性率极低。
