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可能的慢性肺异位移植功能障碍的预后和风险:一个前性的多中心研究.

Jamie L Todd1,2, S Sam Weigt3, Megan L Neely2,4

  • 1Department of Medicine, Duke University Medical Center, Durham, North Carolina.

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概括

可能的慢性肺异位移植功能障碍 (CLAD) 影响了近30%的肺移植接受者在3年内,显著增加了移植损失的风险. 早期识别可能的CLAD对于及时干预和改善存活率至关重要.

关键词:
急性排斥急性排斥慢性肺部异位移植功能障碍 慢性肺部异位移植功能障碍肺部移植 肺部移植

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科学领域:

  • 肺部病理学 肺部病理学
  • 移植免疫学 移植免疫学
  • 临床医学 临床医学

背景情况:

  • 慢性肺异位移植功能障碍 (CLAD) 是长期肺移植成功的主要障碍.
  • 2019年的一项共识定义了基于持续的肺功能下降的可能和确定的CLAD,但可能的CLAD的结果需要进一步调查.

研究的目的:

  • 在多中心肺移植队列中前性评估预后并确定可能的CLAD的临床风险因素.
  • 评估可能的CLAD对移植损失的影响,并将其风险因素与确定的CLAD进行比较.

主要方法:

  • 一项前性的多中心队列研究 (器官移植的临床试验-20) 涉及745名肺移植接受者.
  • 严格判断可能的CLAD,使用2019年的共识定义.
  • 考克斯的比例危险模型,包括LASSO规范化,用于分析移植损失,并确定可能的CLAD的风险因素.

主要成果:

  • 移植后3年,可能的CLAD在29.7%的患者中发生,显著增加了移植损失的风险 (HR=4.38,P<0.001).
  • 80%可能患有CLAD的患者进展为确定的CLAD.
  • 可能的CLAD的主要独立风险因素包括细胞巨乳病毒感染,晚期供体特异性抗体,急性排斥,急性肺损伤和组织性肺炎.

结论:

  • 可能的CLAD作为高移植损失风险的重要早期指标,支持其对迅速的CLAD导向疗法的潜在识别.
  • 制定预防细胞巨乳病毒感染,管理非免疫性和减轻组织损伤的策略对于改善肺移植接受者生存率至关重要.