PDF(Pubmed)
Abstract：
We determined prognostic implications of acute lung injury (ALI) and organizing pneumonia (OP), including timing relative to transplantation, in a multicenter lung recipient cohort. We sought to understand clinical risks that contribute to development of ALI/OP. We analyzed prospective, histologic diagnoses of ALI and OP in 4786 lung biopsies from 803 adult lung recipients. Univariable Cox regression was used to evaluate the impact of early (≤90 days) or late (>90 days) posttransplant ALI or OP on risk for chronic lung allograft dysfunction (CLAD) or death/retransplantation. These analyses demonstrated late ALI/OP conferred a two- to threefold increase in the hazards of CLAD or death/retransplantation; there was no association between early ALI/OP and these outcomes. To determine risk factors for late ALI/OP, we used univariable Cox models considering donor/recipient characteristics and posttransplant events as candidate risks. Grade 3 primary graft dysfunction, higher degree of donor/recipient human leukocyte antigen mismatch, bacterial or viral respiratory infection, and an early ALI/OP event were significantly associated with increased late ALI/OP risk. These data from a contemporary, multicenter cohort underscore the prognostic implications of ALI/OP on lung recipient outcomes, clarify the importance of the timing of these events, and identify clinical risks to target for ALI/OP prevention.
摘要：
我们确定了急性肺损伤（ALI）和机化性肺炎（OP）的预后意义，包括移植的时间安排,在多中心肺受体队列中。我们试图了解导致ALI/OP发展的临床风险。我们分析了前瞻性的，在803例成人肺受者的4786例肺活检中，ALI和OP的组织学诊断。单变量Cox回归用于评估移植后早期（≤90天）或晚期（>90天）ALI或OP对慢性肺同种异体移植功能障碍（CLAD）或死亡/再移植风险的影响。这些分析表明，晚期ALI/OP使CLAD或死亡/再移植的危害增加了两到三倍；早期ALI/OP与这些结果之间没有关联。为了确定晚期ALI/OP的危险因素，我们使用单变量Cox模型,将供体/受体特征和移植后事件作为候选风险.3级原发性移植物功能障碍，供体/受体人类白细胞抗原错配程度较高，细菌或病毒性呼吸道感染，早期ALI/OP事件与晚期ALI/OP风险增加显著相关.这些数据来自当代，多中心队列强调了ALI/OP对肺受体预后的影响，澄清这些事件发生时间的重要性，并确定临床风险，以预防ALI/OP为目标。
