在ABO轻微不兼容的肺移植后,乘客淋巴细胞综合征的高率
Mirjam M Kohl1, Stefan Schwarz2, Peter Jaksch2
1Department of Transfusion Medicine and Cell Therapy.
American journal of respiratory and critical care medicine
|December 11, 2023
概括
乘客淋巴细胞综合征 (PLS) 是轻微的ABO不相容的肺移植 (LuTX) 后的显著风险. 通过红细胞血清学和血液溶解标记来监测PLS对于及时干预至关重要.
科学领域:
- 移植免疫学 移植免疫学
- 血液学 血液学 血液学
- 肺部医学 肺部医学
背景情况:
- 乘客淋巴细胞综合征 (PLS) 可能发生在肺移植 (LuTX) 后,特别是在轻微的 ABO 不相容的情况下.
- 来自捐赠者的红细胞抗体可以诱导受体的血液溶解,导致PLS.
- 了解PLS的发病率和临床影响对于患者管理至关重要.
研究的目的:
- 确定肺移植受体中PLS相关抗体的发生率和特异性.
- 分析患有PLS和没有PLS的患者血液溶解和输血需求的动态.
- 为了比较接受者与没有PLS后的ABO不兼容的LuTX之间的结果.
主要方法:
- 对1,011名LuTX患者 (2010-2019) 的回顾性队列研究和对87名LuTX患者 (2019-2021) 的前性分析.
- 术后评估 ABO 抗体,溶血标志物,输血要求和住院时间.
- 血型A受体O移植的血型A受体与没有PLS的血型A受体的比较.
主要成果:
- 在O移植的A受体中,PLS发病率为18.18% (追溯) 和30.77% (前性).
- 抗A和抗A1是主要的PLS诱导抗体;PLS患者的血红蛋白较低,输血率较高.
- 在其他实验室标志物,住院时间或其他并发症方面没有发现显著差异.
结论:
- 小 ABO 不相容的 LuTX 接受者面临临临床显著 PLS 的实质性风险.
- 建议进行移植后监测,结合红细胞血清学和血液溶解标志物.
- 早期检测血溶性发作对于启动适当的抗原阴性输血治疗至关重要.
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