دورية أكاديمية
Risk Factors for Acute Rejection in the First Year after Lung Transplant. A Multicenter Study.
| العنوان: | Risk Factors for Acute Rejection in the First Year after Lung Transplant. A Multicenter Study. |
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| المؤلفون: | Todd JL; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine.; Duke Clinical Research Institute, and., Neely ML; Duke Clinical Research Institute, and., Kopetskie H; Rho, Durham, North Carolina., Sever ML; Rho, Durham, North Carolina., Kirchner J; Duke Clinical Research Institute, and., Frankel CW; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine., Snyder LD; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine.; Duke Clinical Research Institute, and., Pavlisko EN; Department of Pathology, Duke University Medical Center, Durham, North Carolina., Martinu T; University Health Network, University of Toronto, Toronto, Ontario, Canada., Tsuang W; Cleveland Clinic, Cleveland, Ohio., Shino MY; University of California Los Angeles, Los Angeles, California., Williams N; National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and., Robien MA; National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and., Singer LG; University Health Network, University of Toronto, Toronto, Ontario, Canada., Budev M; Cleveland Clinic, Cleveland, Ohio., Shah PD; John Hopkins University, Baltimore, Maryland., Reynolds JM; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine., Palmer SM; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine.; Duke Clinical Research Institute, and., Belperio JA; University of California Los Angeles, Los Angeles, California., Weigt SS; University of California Los Angeles, Los Angeles, California. |
| المصدر: | American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2020 Aug 15; Vol. 202 (4), pp. 576-585. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, N.I.H., Extramural |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2000- : New York, NY : American Thoracic Society Original Publication: New York, NY : American Lung Association, c1994- |
| مواضيع طبية MeSH: | Lung Transplantation*, Bronchiolitis/*epidemiology , Graft Rejection/*epidemiology , Postoperative Complications/*epidemiology, Acute Disease ; Aged ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Time Factors |
| مستخلص: | Rationale: Acute rejection, manifesting as lymphocytic inflammation in a perivascular (acute perivascular rejection [AR]) or peribronchiolar (lymphocytic bronchiolitis [LB]) distribution, is common in lung transplant recipients and increases the risk for chronic graft dysfunction. Objectives: To evaluate clinical factors associated with biopsy-proven acute rejection during the first post-transplant year in a present-day, five-center lung transplant cohort. Methods: We analyzed prospective diagnoses of AR and LB from over 2,000 lung biopsies in 400 newly transplanted adult lung recipients. Because LB without simultaneous AR was rare, our analyses focused on risk factors for AR. Multivariable Cox proportional hazards models were used to assess donor and recipient factors associated with the time to the first AR occurrence. Measurements and Main Results: During the first post-transplant year, 53.3% of patients experienced at least one AR episode. Multivariable proportional hazards analyses accounting for enrolling center effects identified four or more HLA mismatches (hazard ratio [HR], 2.06; P ≤ 0.01) as associated with increased AR hazards, whereas bilateral transplantation (HR, 0.57; P ≤ 0.01) was associated with protection from AR. In addition, Wilcoxon rank-sum analyses demonstrated bilateral (vs. single) lung recipients, and those with fewer than four (vs. more than four) HLA mismatches demonstrated reduced AR frequency and/or severity during the first post-transplant year. Conclusions: We found a high incidence of AR in a contemporary multicenter lung transplant cohort undergoing consistent biopsy sampling. Although not previously recognized, the finding of reduced AR in bilateral lung recipients is intriguing, warranting replication and mechanistic exploration. |
| التعليقات: | Comment in: Am J Respir Crit Care Med. 2020 Aug 15;202(4):486-488. (PMID: 32603183) |
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| معلومات مُعتمدة: | K23 HL138256 United States HL NHLBI NIH HHS; U01 AI113315 United States AI NIAID NIH HHS; UM2 AI117870 United States AI NIAID NIH HHS |
| فهرسة مساهمة: | Keywords: acute rejection; lung transplantation; lymphocytic bronchiolitis |
| تواريخ الأحداث: | Date Created: 20200508 Date Completed: 20201112 Latest Revision: 20231118 |
| رمز التحديث: | 20240829 |
| مُعرف محوري في PubMed: | PMC7427399 |
| DOI: | 10.1164/rccm.201910-1915OC |
| PMID: | 32379979 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1535-4970 |
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| DOI: | 10.1164/rccm.201910-1915OC |