Kshettry V R, Kroshus T J, Savik K, Hertz M I, Bolman R M
Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis 55455, USA.
Chest. 1996 Sep;110(3):704-9. doi: 10.1378/chest.110.3.704.
Obliterative bronchiolitis (OB) is a major factor limiting long-term survival after lung transplantation. The etiology of this disease process remains incompletely understood. Several risk factors have been identified previously, including acute rejection and cytomegalovirus pneumonitis. The purpose of this study was to evaluate primary pulmonary hypertension (PPH) as a potential risk factor for the development of OB after lung transplantation.
We retrospectively analyzed 107 lung allograft recipients (28 heart-lung, 18 bilateral sequential single-lung, 61 single-lung) who underwent transplantation between May 1, 1986, and April 30, 1994, and survived at least 3 months posttransplant. Mean follow-up posttransplant was 28.6 months (range, 3.5 to 99 months). Actuarial survival was estimated for patients with or without PPH and for those who did or did not develop OB.
In all, 25 patients (23.4%) developed OB, diagnosed by strict histologic criteria. Of 23 patients with PPH, 9 (39.1%) developed OB, compared with 16 (19.0%) of 84 patients without PPH (p = 0.044). Actuarial survival, sex, time on waiting list, and follow-up posttransplant were not significantly different between groups. PPH was the major determinant for the development of OB (p = 0.0468) when evaluating PPH and cytomegalovirus pneumonitis together as risk factors. Patients with PPH also developed OB significantly earlier posttransplant, compared with patients with other primary disease (p = 0.05).
Patients with PPH who undergo lung transplantation are at increased risk for the development of OB, which also occurs at a shorter time interval posttransplant. This subgroup needs aggressive monitoring for diagnosis and treatment of OB.
闭塞性细支气管炎（OB）是限制肺移植后长期生存的主要因素。该疾病过程的病因仍未完全明确。先前已确定了几个危险因素，包括急性排斥反应和巨细胞病毒性肺炎。本研究的目的是评估原发性肺动脉高压（PPH）作为肺移植后发生OB的潜在危险因素。
我们回顾性分析了1986年5月1日至1994年4月30日期间接受移植且移植后至少存活3个月的107例肺移植受者（28例心肺联合移植、18例双侧序贯单肺移植、61例单肺移植）。移植后的平均随访时间为28.6个月（范围3.5至99个月）。对有或无PPH以及发生或未发生OB的患者进行了精算生存估计。
总共有25例患者（23.4%）发生OB，通过严格的组织学标准诊断。在23例PPH患者中，9例（39.1%）发生OB，而84例无PPH患者中有16例（19.0%）发生OB（p = 0.044）。两组之间的精算生存、性别、等待名单上的时间以及移植后的随访时间无显著差异。将PPH和巨细胞病毒性肺炎作为危险因素一起评估时，PPH是发生OB的主要决定因素（p = 0.0468）。与其他原发性疾病患者相比，PPH患者移植后发生OB的时间也显著更早（p = 0.05）。
接受肺移植的PPH患者发生OB的风险增加，且在移植后较短时间内发生。该亚组需要积极监测以诊断和治疗OB。
