Nunley D R, Grgurich W, Iacono A T, Yousem S, Ohori N P, Keenan R J, Dauber J H
Division of Transplantation Medicine, University of Pittsburgh, PA, USA.
Chest. 1998 May;113(5):1235-43. doi: 10.1378/chest.113.5.1235.
To assess the incidence of pseudomonal infection, colonization, and inflammation in the allograft of lung transplant recipients with cystic fibrosis (CF) as compared with recipients with other end-stage lung disease.
Retrospective review.
University medical center transplant service.
All patients with CF and chronic pseudomonal infection (n=62) and patients with nonseptic end-stage lung disease (n=52) receiving a double lung transplant between October 1983 and March 1996.
Fifty lung transplant recipients with CF survived beyond postoperative day (POD) 15 and were subject to sequential bronchoscopy with BAL. Forty-four CF lung transplant recipients had Pseudomonas isolated from the allograft by median POD 15 as compared with 21 non-CF lung transplant recipients (p<0.001) with isolation at median POD 158 (p<0.0001). Thirteen CF lung transplant recipients had histologic evidence of infection when Pseudomonas was isolated as compared with only three of the non-CF lung transplant recipients (p<0.01). These infections occurred earlier in the CF lung transplant recipients (median POD 10 vs 261) (p<0.01). When compared with non-CF lung transplant recipients, CF lung transplant recipients with Pseudomonas isolated but without concomitant histologic infection (colonized) were demonstrated to have increased number of polymorphonuclear cells (PMNs) in the BAL fluid recovered from the allograft (17.66+/-24.94 x 10(6) cells vs 3.46+/-4.73 x 10(6)) (p<0.05). Non-CF lung transplant recipients who became colonized with Pseudomonas also had a greater number of PMNs recovered when compared with non-CF lung transplant recipients who did not have Pseudomonas (22.32+/-34.00 x 10(6) cells vs 0.21+/-0.18 x 10(6)) (p<0.01). Nine of 32 (28%) lung transplant recipients with CF have died from pseudomonal allograft infections, but this is no greater than 4 of 21 (19%) deaths related to Pseudomonas infection in recipients without CF (p=0.34).
Isolation of Pseudomonas from the lung allograft occurs more frequently and earlier after transplantation in recipients with CF. While infections related to Pseudomonas also occur more frequently in recipients with CF, there is no increase in mortality. There is an intense inflammatory response in the lung allograft associated with the isolation of Pseudomonas in recipients with and without CF.
评估囊性纤维化（CF）肺移植受者与其他终末期肺病受者相比，其移植肺中铜绿假单胞菌感染、定植及炎症的发生率。
回顾性研究。
大学医学中心移植科。
1983年10月至1996年3月期间接受双肺移植的所有CF合并慢性铜绿假单胞菌感染患者（n = 62）及非感染性终末期肺病患者（n = 52）。
50例CF肺移植受者术后存活超过第15天，并接受了序贯支气管镜检查及支气管肺泡灌洗（BAL）。44例CF肺移植受者在术后第15天（中位数）时从移植肺中分离出铜绿假单胞菌，相比之下，21例非CF肺移植受者在术后第158天（中位数）时分离出该菌（p < 0.001）（p < 0.0001）。13例CF肺移植受者在分离出铜绿假单胞菌时有组织学感染证据，相比之下，非CF肺移植受者仅有3例（p < 0.01）。这些感染在CF肺移植受者中出现得更早（中位数为术后第10天 vs 261天）（p < 0.01）。与非CF肺移植受者相比，CF肺移植受者虽分离出铜绿假单胞菌但无组织学感染（定植），其从移植肺回收的BAL液中多形核白细胞（PMN）数量增加（17.66±24.94×10⁶细胞 vs 3.46±4.73×10⁶）（p < 0.05）。与未感染铜绿假单胞菌的非CF肺移植受者相比，感染铜绿假单胞菌的非CF肺移植受者回收的PMN数量也更多（22.32±34.00×10⁶细胞 vs 0.21±0.18×10⁶）（p < 0.01）。32例CF肺移植受者中有9例（28%）死于移植肺铜绿假单胞菌感染，但这并不高于21例非CF受者中4例（19%）死于铜绿假单胞菌感染的比例（p = 0.34）。
CF受者移植肺中铜绿假单胞菌的分离在移植后更频繁且更早出现。虽然CF受者中与铜绿假单胞菌相关的感染也更频繁，但死亡率并未增加。在感染和未感染铜绿假单胞菌的受者中，移植肺均存在与铜绿假单胞菌分离相关的强烈炎症反应。
