Judson M A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, USA.
Eur Respir J. 1998 Mar;11(3):738-44.
Patients with end-stage sarcoidosis have now undergone lung transplantation successfully with good short-term and intermediate-term results. Lung transplantation for sarcoidosis requires several considerations unique to this disease. Selection of pulmonary sarcoidosis patients for transplantation requires that medical therapy has been exhausted. This may involve the use of corticosteriods and alternative medications. Causes of pulmonary dysfunction other than pulmonary sarcoidosis, such as bronchiectasis and myocardial sarcoidosis, must be excluded before candidates are considered for transplantation. The extent and severity of extrapulmonary disease must also be assessed and may preclude lung transplantation. The presence of mycetomas is considered a relative contra-indication by some transplant centres and an absolute contra-indication by others. Relatively few patients with pulmonary sarcoidosis have undergone transplantation and, therefore, there are few data on outcome. Sarcoidosis frequently recurs in the allograft, but rarely causes symptoms or pulmonary dysfunction. More severe acute rejection episodes may occur in sarcoidosis transplant recipients, although at present there is no evidence of an increased risk of obliterative bronchiolitis or increased mortality.
终末期结节病患者现已成功接受肺移植，短期和中期效果良好。结节病的肺移植需要考虑该疾病特有的几个因素。选择肺结节病患者进行移植需要在穷尽药物治疗之后。这可能涉及使用皮质类固醇和其他替代药物。在考虑将患者作为移植候选者之前，必须排除除肺结节病之外的其他导致肺功能障碍的原因，如支气管扩张和心肌结节病。还必须评估肺外疾病的范围和严重程度，这可能会排除肺移植。一些移植中心认为曲菌球的存在是相对禁忌证，而其他中心则认为是绝对禁忌证。接受肺移植的肺结节病患者相对较少，因此关于治疗结果的数据也很少。结节病在同种异体移植中经常复发，但很少引起症状或肺功能障碍。结节病移植受者可能会发生更严重的急性排斥反应，尽管目前没有证据表明闭塞性细支气管炎的风险增加或死亡率升高。
