Immunologically Mediated Disease of the Airways after Pulmonary Transplantation
| Autor: | Bartley P. Griffith, Rene J. Duquesnoy, Samuel A. Yousem, H. Rabinowich, Robert L. Hardesty, James H. Dauber, Irvin L. Paradis, Zeevi A |
|---|---|
| Rok vydání: | 1988 |
| Předmět: |
Graft Rejection
Lymphocyte Bronchiolitis obliterans Pulmonary function testing Postoperative Complications medicine Humans Lymphocytes Bronchiolitis Obliterans Lung medicine.diagnostic_test business.industry Respiratory disease medicine.disease Respiratory Function Tests Transplantation Phenotype medicine.anatomical_structure Bronchoalveolar lavage Bronchiolitis Immunology Heart Transplantation Dimercaprol Surgery business Research Article Lung Transplantation |
| Zdroj: | Annals of Surgery. 208:371-378 |
| ISSN: | 0003-4932 |
| Popis: | Obliterative bronchiolitis has occurred in eleven of 30 recipients of cardiopulmonary allografts who survived at least 4 months after transplantation, has caused significant morbidity, and has been associated with four of eleven late deaths in this series. Although some improvement, or at least stability, of pulmonary function has followed augmented immune suppression, it appears that once the process is recognized clinically, much of the damage to the airways is irreversible. The histopathology, response to therapy, and, most important, the response of donor specific alloreactivity in the lymphocytes from the lung (bronchoalveolar lavage and peripheral blood) suggest immune- mediated basis for bronchiolitis obliterans. The presence of donor specific alloreactivity detected by primed lymphocyte testing predicted obliterative bronchiolitis in five of six recipients (83% sensitivity, 91% specificity) was absent in ten of eleven recipients who have not as yet developed the process (negative predicted value of 91%). Currently, the presence of a positive primed lymphocyte test in the bronchoalveolar lavage of the cardiopulmonary recipient is an indication for early treatment by augmented immune suppression. |
| Databáze: | OpenAIRE |
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