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移植前的肺部感染治疗后的肺移植结果
Prasanth Balasubramanian1, Aditya Khanijo2, Brad A White3
1Department of Transplantation, Division of Lung Failure and Transplant, Mayo Clinic, Jacksonville, Florida, USA.
概括
完整的肺移植前 (LT) 治疗Mycobacterium avium复合体 (MAC) 感染可能会防止LT后的复发. 然而,LT前MAC治疗的整体益处仍然不确定,特别是在患有间歇性肺病 (ILD) 的患者中.
科学领域:
- 肺部医学 肺部医学
- 传染性疾病 传染性疾病
- 移植手术 移植手术
背景情况:
- 在肺移植 (LT) 之前,Mycobacterium avium复合体 (MAC) 感染带来了治疗挑战,并带来了长时间的治疗和副作用.
- 前LT MAC治疗对后LT复发和结果的影响还不清楚,特别是在间歇性肺病 (ILD) 患者中.
- 患有ILD的患者的平均存活时间不到2年,这使治疗决策复杂化.
研究的目的:
- 评估移植前Mycobacterium avium复合体 (MAC) 治疗对肺移植 (LT) 后复发和结果的影响.
- 根据LT前MAC治疗的程度,比较MAC复发,死亡率和肺功能 (FEV-1,FVC).
主要方法:
- 在梅奥诊所对成年LT患者进行了前LTMAC唾液培养的回顾性队列研究.
- 患者按LT前MAC肺部感染治疗分层:完全,部分或没有治疗.
- 主要结果:LT后的MAC复发. 二次结局:死亡率,FEV-1和FVC在LT后的一年.
主要成果:
- 在47名患者中,19.1%接受了部分治疗,23.4%接受了完整的LT前MAC治疗.
- 在LT后的MAC复发发生在总队列的17%,在完全治疗 (0%) 和部分治疗 (44.4%) 或未治疗 (14.8%) 的患者中明显较低 (p=0.026).
- 根据LT前治疗或LT后复发,没有观察到死亡率或1年FEV-1/FVC的显著差异.
结论:
- 完整的移植前MAC治疗似乎可以减少肺移植后的复发.
- 移植前MAC治疗的整体作用值得怀疑,特别是在ILD患者治疗时间有限的情况下.
- 需要进一步的研究来优化LT候选人的MAC治疗策略.
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