Clinical efficacy of lung transplantation for lung chronic graft-versus-host disease after hematopoietic stem cell transplantation
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摘要:
目的 探讨肺移植治疗造血干细胞移植(HSCT)后肺部慢性移植物抗宿主病(cGVHD)的疗效。 方法 回顾性分析因肺部cGVHD接受肺移植治疗的12例患者的临床资料。分析患者的术前临床表现及累及器官,对比肺移植前后肺功能,分析患者肺移植术后生存情况。 结果 11例患者因原发血液系统恶性疾病行HSCT,其中白血病9例、骨髓增生异常综合征1例、淋巴瘤1例,1例因系统性红斑狼疮行HSCT。12例cGVHD患者中,8例同时累及皮肤,5例同时累及口腔,4例同时累及胃肠道,3例同时累及肝脏。12例患者肺移植术前均存在严重肺部cGVHD导致的呼吸衰竭,其中表现为Ⅱ型呼吸衰竭9例;表现为Ⅰ型呼吸衰竭3例。肺移植手术方式包括右肺移植2例、左肺移植2例、双肺移植8例。从接受HSCT到接受肺移植的间隔时间为75(19~187)个月。截至投稿日,随访时间为18(7~74)个月,其中10例患者存活,1例于术后22个月死于重症肝炎,另外1例于术后6个月死于消化道大出血,存活患者均未发现原发病复发。 结论 肺移植是治疗HSCT后肺部cGVHD的一种有效手段,可延长患者生存时间并提高生活质量。 Abstract:Objective To evaluate clinical efficacy of lung transplantation for lung chronic graft-versus-host disease (cGVHD) after hematopoietic stem cell transplantation (HSCT). Methods Clinical data of 12 patients undergoing lung transplantation for lung cGVHD were retrospectively analyzed. Preoperative clinical manifestations and involved organs of patients were analyzed. The lung function before and after lung transplantation was compared, and the survival of patients after lung transplantation was analyzed. Results 11 patients underwent HSCT due to primary hematological malignancies, including 9 cases of leukemia, 1 case of myelodysplastic syndrome, 1 case of lymphoma. And 1 case underwent HSCT for systemic lupus erythematosus. Among 12 cGVHD patients, skin involvement was found in 8 cases, oral cavity involvement in 5 cases, gastrointestinal tract involvement in 4 cases and liver involvement in 3 cases. All 12 patients developed severe respiratory failure caused by cGVHD before lung transplantation, including 9 cases of typeⅡ respiratory failure and 3 cases of type Ⅰ respiratory failure. Two patients underwent right lung transplantation, 2 cases of left lung transplantation and 8 cases of bilateral lung transplantation. The interval from HSCT to lung transplantation was 75 (19-187) months. Upon the date of submission, postoperative follow-up time was 18 (7-74) months. Ten patients survived, 1 died from severe hepatitis at postoperative 22 months, and 1 died from gastrointestinal bleeding at postoperative 6 months. No recurrence of primary diseases was reported in surviving patients. Conclusions Lung transplantation is an efficacious treatment for lung cGVHD after HSCT, which may prolong the survival time and improve the quality of life of the recipients. -
表 1 12例接受肺移植患者的临床资料
Table 1. Clinical data of 12 patients receiving lung transplantation
例号 性别 年龄(岁) 术前BMI
(kg/m2)原发病 肺移植指征 HSCT日期 骨髓
配型累及器官 肺移植
日期术式 术后情况 现生存情况 6分钟步行试验(m) 1 男 20 16.4 ALL① BOS 2018年7月30日 全相合 肺、皮肤、口腔、肝脏、胃肠道 2020年3月19日 双肺移植 顺利出院 良好 404 2 女 35 15.8 AML② BOS 2006年6月 全相合 肺、皮肤、
肝脏2021年8月9日 双肺移植 顺利出院 良好 376 3 男 19 17.0 AML BOS 2018年3月29日 半相合 肺、肝脏 2021年8月14日 双肺移植 顺利出院 良好 650 4 女 37 11.7 MDS③ BOS 2017年6月 全相合 肺、眼睛 2021年11月23日 双肺移植 顺利出院 良好 460 5 女 39 14.8 ALL BOS 2014年7月 全相合 肺、口腔 2021年12月15日 双肺移植 顺利出院 良好 330 6 男 33 24.7 ALL BOS 2006年7月 全相合 肺、皮肤、口腔、胃肠道 2022年2月12日 双肺移植 顺利出院 良好 488 7 男 38 14.9 ALL BOS 2006年6月 全相合 肺、口腔 2022年2月9日 左肺移植 顺利出院 良好 325 8 男 39 13.9 AML ILD 2013年5月 全相合 肺、胃肠道、皮肤 2022年3月10日 右肺移植 顺利出院 术后6个月死亡 —④ 9 男 31 15.6 ALL BOS 2017年7月 全相合 肺、口腔、眼睛、皮肤 2022年10月16日 双肺移植 顺利出院 良好 480 10 女 42 14.1 ALL BOS 2019年7月26日 半相合 肺、眼睛、指甲、皮肤、胃肠道 2022年9月21日 双肺移植 顺利出院 良好 457 11 女 41 21.1 SLE ILD 2007年4月8日 半相合 肺、皮肤 2017年3月11日 右肺移植 顺利出院 良好 400 12 男 29 17.2 淋巴瘤 PPFE 2011年9月14日 半相合 肺、皮肤 2016年3月5日 左肺移植 顺利出院 术后22个月死亡 — 注:①ALL为急性淋巴细胞白血病。
②AML为急性髓系白血病。
③MDS为骨髓异常增生综合征。
④—为无数据。 -
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