RESUMEN
Local immunological injury caused by acute lung rejection leads to fibroblast proliferation. Hyaluronate is a product of activated fibroblasts and possibly an indicator of fibroblast proliferation. One hundred thirty-six bronchoalveolar lavage and plasma hyaluronate assays were performed in 57 lung transplant recipients. Pulmonary endothelial cell function was assessed by measuring bronchoalveolar lavage levels of purine nucleoside phosphorylase. Presence of acute cellular rejection was monitored by transbronchial biopsy histologic evaluation and was classified as minimal to mild (acute rejection I, II) and moderate to severe (acute rejection III, IV). Infection was confirmed by bronchoalveolar lavage culture and antibiotic sensitivity. Bronchoalveolar lavage hyaluronate levels in clinically stable recipients were 33.5 +/- 4.69 micrograms/L and were significantly higher than with clinically stable recipients (p = 0.0001), infection (p = 0.008), or mild rejection (p = 0.001). Levels were highest in recipients with diffuse alveolar damage (392.4 +/- 60.6 micrograms/L). Diffuse alveolar damage also resulted in significant elevations of plasma HA as compared with stable recipients (p = 0.001) and mild rejection. We conclude that clinically significant injury to the allograft from rejection or diffuse alveolar damage can be assessed by bronchoalveolar lavage hyaluronate assays and suggest that the source of hyaluronate in these instances are activated fibroblasts.
Asunto(s)
Líquido del Lavado Bronquioalveolar/química , Rechazo de Injerto/diagnóstico , Ácido Hialurónico/análisis , Infecciones/diagnóstico , Trasplante de Pulmón , Complicaciones Posoperatorias/diagnóstico , Enfermedad Aguda , Femenino , Humanos , Ácido Hialurónico/sangre , Infecciones/etiología , Enfermedades Pulmonares/diagnóstico , Masculino , Purina-Nucleósido Fosforilasa/análisisRESUMEN
Microchimerism in lung allograft recipients was studied in the autopsies of nine female recipients of male lung grafts who had survived for more than 1 month after transplantation. Using a Y chromosome-specific probe tissues were studied for the presence of donor cells that had migrated beyond the graft itself. They were quantitated by cell counting to give absolute numbers of cells per organ volume. While donor cells were disseminated throughout the body, their numbers were small. These absolute numbers should be studied in a larger group of recipients to determine if they correlate with prognosis and the development of bronchiolitis obliterans.
Asunto(s)
Quimera , Leucocitos/citología , Trasplante de Pulmón/patología , Inmunología del Trasplante/genética , Trasplante Homólogo/patología , Cromosoma Y , Adulto , Sondas de ADN , Femenino , Humanos , Hibridación in Situ , Masculino , Persona de Mediana EdadRESUMEN
In the last 10 years, lung transplantation has become an increasingly common procedure for patients with end-stage respiratory disease. Although long-term survival can be achieved, there is still significant morbidity within the first year. Early postoperative problems that may be anticipated include respiratory insufficiency, airway anastomotic problems, hemorrhage, infection, and episodes of acute rejection. These problems and others make the immediate perioperative period particularly challenging. With aggressive management, however, the probability of a successful outcome can be enhanced.
Asunto(s)
Cuidados Críticos/métodos , Trasplante de Pulmón , Rechazo de Injerto/prevención & control , Rechazo de Injerto/terapia , Humanos , Cuidados Posoperatorios , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapia , Infección de la Herida Quirúrgica/prevención & control , Resultado del TratamientoRESUMEN
Heart-lung transplant recipients are predisposed to acute rejection episodes, bronchiolitis obliterans, and opportunistic infections. In 9.4% of recipients at the University of Pittsburgh, a posttransplant lymphoproliferative disorder (PTLD) developed, and in 60% of cases, it presented in the allografted lungs and was associated with primary infection by Epstein-Barr virus (EBV). The PTLD is histologically indistinguishable from a primary pulmonary lymphoma and consists of a mixed population of large lymphoid cells, immunoblasts, and plasma cells. Two cases of PTLD were monoclonal with immunohistochemical and Southern blot analysis. Despite this, there was clinical recovery with reduced immunosuppression and acyclovir. We discuss the role of EBV in the development of PTLD and the pathogenesis of primary presentation in the allograft.
Asunto(s)
Trasplante de Corazón , Trasplante de Corazón-Pulmón , Trasplante de Pulmón , Trastornos Linfoproliferativos/etiología , Complicaciones Posoperatorias , Adolescente , Biopsia , Células Clonales , ADN Viral/análisis , Herpesvirus Humano 4/genética , Humanos , Inmunohistoquímica , Pulmón/análisis , Pulmón/patología , Trastornos Linfoproliferativos/patología , Trasplante HomólogoRESUMEN
Abnormal ventilatory function is common in patients with neuromuscular disorders. This report describes depressed ventilatory response to both hypoxia and hypercapnia, as well as arterial oxygen desaturation during sleep in a family with congenital myopathy. The index patient also had an abnormal ventilatory response to metabolic acid loading. There was clinical evidence of proximal muscle weakness, and a muscle biopsy specimen was consistent with myopathy. The reduction in ventilatory drive, however, could not be explained solely by ventilatory muscle weakness. This report describes a distinct familial syndrome of congenital myopathy and abnormal ventilatory response to hypercapnia and hypoxia. All affected family members had unique facial features, proximal muscle weakness, and impaired ventilatory responses. The combination of impaired ventilatory drive and reduced ventilatory muscle strength leaves patients particularly vulnerable, and heightened awareness of this association is important in the treatment of these patients.