心肺移植后的肺再移植:一个案例报告
Abdullah Laradhi1, Bassam Al Otary1, Mohannad Dawary2
1Alfaisal University, Riyadh, Saudi Arabia.
Transplantation proceedings
|February 6, 2026
概括
心肺移植后的肺再移植是罕见的,但可行. 这一案例显示,通过密切监测和针对慢性肺异位移植功能障碍的定制免疫抑制,取得了成功的结果.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 移植免疫学 移植免疫学
背景情况:
- 心肺移植后的肺再移植是不常见的,造成手术和免疫学障碍.
- 一名患有先天性心脏病和艾森门格综合征的24岁男性接受了心肺移植手术.
- 移植后慢性肺异位功能障碍 (CLAD) 发生在2年后,其特征是肺功能减弱和捐赠者特异性抗体 (DSAs).
研究的目的:
- 报告之前心肺移植后成功进行双边肺再移植的病例.
- 为了说明慢性肺异位移植功能障碍 (CLAD) 和抗体介导排斥的管理.
- 突出复杂的移植后情景中再移植的可行性.
主要方法:
- 一名24岁的男性患者在经历心肺移植后的CLAD后接受了双边肺再移植.
- 管理包括氧气治疗,双层阳性气道压力,以及对排斥发作的支持性护理.
- 免疫抑制疗法涉及静脉注射治疗. 免疫球蛋白,rituximab,等离子体异位,和反细胞球蛋白用于复发的DSAs.
主要成果:
- 该患者经历了成功的双边肺再移植,没有出现重大手术内并发症.
- 手术后的康复需要对肺栓塞和复发性II类DSA (抗DQ8,抗DR5) 进行管理.
- 最近的评估显示了稳定的移植功能,在支气管支气管洗和活检上没有急性排斥的迹象.
结论:
- 心肺移植后的肺再移植在选定的患者中是可行的.
- 密切监测,个性化免疫抑制和多学科护理对于有利的长期结果至关重要.
- 这一案例证明了复杂的移植后情景的成功管理,包括CLAD和抗体介导排斥.
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