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肺移植后肠道和肺上腺肺炎:单中心经验和系统审查

Hiroshi Kagawa^1,2, Masashi Furukawa¹, Ernest Chan¹

¹Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Journal of transplantation

|October 25, 2024

概括

肺炎肠道和肺上腺炎是肺移植后的严重并发症. 这些疾病与高排斥率和死亡率有关,需要谨慎的管理策略.

科学领域:

胃肠病学胃肠病学
肺部病理学肺部病理学
移植手术移植手术

背景情况:

肺炎肠道 (PI) 和肺上腺 (pneumoperitoneum) 是肺移植 (LT) 后的已知并发症,但不经常报告.
关于这些LT后胃肠道并发症的发病率,风险因素和最佳管理的公布数据有限.

研究的目的:

审查机构对PI和LT后的肺上皮层的经验.
进行系统审查,以阐明这些并发症的原因,风险因素和管理策略.

主要方法:

在LT后 (2013-2022) 进行PI或肺皮患者的回顾性评估.
系统的文献审查,以寻找额外的病例和管理数据.
对患者特征,干预措施和结果的分析.

主要成果:

机构队列中2.06%的LT接受者 (15/729) 发生PI和肺;在系统性审查中确定了50名额外的患者.
相关手术的高率 (气管切除术40%,肠道肠道手术55.6%) 和并发症 (排斥42.9%).
死亡率为28.6%;风险因素包括机械通风,气管切除,胃肠道手术,CMV,C. difficile感染和免疫抑制.

结论:

这项研究代表了LT后最大的PI和肺上皮层队列,突出显著的发病率和死亡率.
管理决策应以临床表现和实验室发现为指导,腹腔切除术适用于严重症状 (例如门静脉气体,酸化).
保守的管理对特定的患者是有效的,包括肠休息,抗生素和免疫抑制的调整 (例如,保持MMF).

关键词:

肺炎症是肠道性肺炎.肺上腺; 肺移植; 肺移植.

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