肺移植术后早期抗体介导排斥反应1例及文献复习  

Early stage of antibody-mediated rejection after lung transplantation:A case report and literature review

作　　者：夏振坤[1] 陈名久[1] 卿蓓 王巍 顾林果 袁运长[1] XIA Zhenkun;CHEN Mingjiu;QING Bei;WANG Wei;GU Linguo;YUAN Yunchang(Department of Thoracic Surgery,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院胸外科,长沙410011

出　　处：《中南大学学报（医学版）》2021年第10期1172-1176,共5页Journal of Central South University ：Medical Science

摘　　要：抗体介导排斥反应(antibody-mediated rejection,AMR)是肺移植术后一种少见而严重的并发症,无特征性病理表现,无系统的标准治疗方案,治疗效果及预后较差。现报告1例肺移植术后早期AMR的病例并进行相关文献复习。本病例为男性患者,于右肺移植术后第99天出现感冒症状,经对症治疗后好转,14 d后突发气促、发热,抗细菌、真菌、病毒及卡氏肺孢子虫治疗无效,予1 000 mg甲基强的松龙治疗无效,患者病情迅速加重,予气管插管使其维持呼吸。血清群体反应性抗体和供体特异性抗体检查示:人白细胞抗原(humen leukocyte antigen,HLA)Ⅱ类抗体阳性,经纤维支气管镜对移植肺取活体组织行病理检查提示急性排斥反应。结合供体特异性抗体和临床表现诊断为AMR。予兔抗人胸腺细胞免疫球蛋白+利妥昔单抗注射液+血浆置换+免疫球蛋白治疗后患者的呼吸功能恢复正常,随访3年未发生慢性移植肺功能衰竭。肺移植后受者突然出现气促、发热,常规抗感染及抗细胞排斥反应治疗无效时应警惕其发生AMR。经纤维支气管镜移植肺活体组织检查、血清供体特异性抗体检测有助于明确诊断。治疗应抓紧时机,采用综合治疗的方法。Antibody-mediated rejection(AMR) is a rare and serious complication after lung transplantation, with no characteristic of pathological manifestation, no systematic standard treatment, and the poor efficacy and prognosis. We reported a case of early AMR after lung transplantation and the relevant literature has been reviewed. A male patient presented with symptoms of cold 99 days after transplantation and resolved after symptomatic treatment.He admitted to the hospital 14 days later because of a sudden dyspnea and fever. Antibacteria, anti-fungi, anti-virus, and anti-pneumocystis carinii treatment were ineffective,and a dose of 1 000 mg methylprednisolone did not work too. The patient’ s condition deteriorated rapidly and tracheal intubation was done to maintain breathing. Serum panel reactive antibody and donor specific antibody showed postive in humen leukocyte antigen(HLA) Ⅱ antibody. Pathological examination after transbronchial transplantation lung biopsy showed acute rejection. Clinical AMR was diagnosed combined the donor-specific antibody with the pathological result. The patient was functionally recovered after combined treatment with thymoglobuline, rituximab, plasmapheresis, and immunoglobulin.No chronic lung allograft dysfunction was found after 3 years follow up. We should alert the occurrence of AMR in lung transplantation recipient who admitted to hospital with a sudden dyspnea and fever while showed no effect after common anti-infection and antirejection treatment. Transbronchial transplantation lung biopsy and the presence of serum donor-specific antibody are helpful to the diagnosis. The treatment should be preemptive and a comprehensive approach should be adopted.

关 键 词：肺移植 抗体介导排斥反应 治疗 

分 类 号：R655.3[医药卫生—外科学]