Sleiman C, Groussard O, Mal H, Fournier M
Service de Pneumologie et Réanimation, Hôpital Beaujon, Clichy, France.
Rev Mal Respir. 1996 Nov;13(5 Suppl):S31-40.
Three complications which influence both survival and quality of life in transplanted patients will be the object of this chapter. Graft dysfunction: this is a severe re-implantation oedema leading to inefficiency of the graft as regards haemostasis whether or not associated with haemodynamic complications. The liberation of free radicals and/or cytokines induced by ischemia-reperfusion of the graft plays an important role in the pathogenesis of this syndrome. Acute rejection: the mechanism is complex leading to the intervention of an immune response stimulated by the detection of allo-antigens. The clinical picture is often non-specific. Treatment requires boluses of methyl prednisolone completed by decreasing dose of corticosteroid therapy orally. The syndrome of bronchiolitis obliterans: this is a progressive failure of the airways. This syndrome occurs in the long term in 50% of patients and presents with progressive dyspnoea associated with persistent or recurrent cough. The pathogenesis is brought about principally by a chronic rejection with a specific cytotoxic reaction of T lymphocytes against the airway epithelium which expresses Class II major histocompatibility antigens. Attempts at curative treatment can be extremely deceptive and leads to, at best, a slowing in decline of respiratory function.
本章将关注影响移植患者生存及生活质量的三种并发症。移植物功能障碍：这是一种严重的再植入水肿，无论是否伴有血流动力学并发症，都会导致移植物在止血方面效率低下。移植物缺血再灌注诱导的自由基和/或细胞因子释放，在该综合征的发病机制中起重要作用。急性排斥反应：其机制复杂，是由同种异体抗原检测刺激免疫反应介入所致。临床表现往往不具特异性。治疗需要大剂量甲泼尼龙冲击治疗，随后口服逐渐减量的皮质类固醇疗法。闭塞性细支气管炎综合征：这是一种进行性气道功能衰竭。该综合征在50%的患者中长期出现，表现为进行性呼吸困难，并伴有持续或反复咳嗽。其发病机制主要由慢性排斥反应引起，即T淋巴细胞对表达II类主要组织相容性抗原的气道上皮产生特异性细胞毒性反应。根治性治疗的尝试可能极具欺骗性，充其量只能减缓呼吸功能的衰退。
