同种异体肺移植免疫抑制治疗2例报告

Clinical Experience of Immunosuppression Therapy in Lung Allotransplantation(Report of 2 Cases)

目的探讨肺移植术后急性排异反应的监测及免疫抑制治疗。方法2例终末期肺病患者接受肺移植;1例行右单肺移植,1例行左肺移植联合右肺减容术。围术期采用赛尼哌进行免疫诱导,维持治疗为环孢素A(CSA)+吗替麦考酚酯(MMF)+强的松(Pred)三联免疫抑制方案;监测移植肺急性排异反应。结果2例患者移植后2个多月均顺利康复出院。分别随访14个月和8个月,肺活量达1 700 mL和2 000 mL,生活质量明显改善。结论围术期采用赛尼哌免疫诱导预防移植肺急性排异反应,效果较佳;临床表现、肺部影像学和纤维支气管镜活检有助于监测移植肺排异反应。

Objective To survey immunosuppression therapy and monitoring of acute rejection in two lung allotransplant patient.Methods Two patients with end-stage pulmonary disease underwent single-lung transplantation received induction therapy with an interleukin 2 receptor antibody daclizumab perioperative.Cyclosporine,mycophenolate mofetil and prednisolone were applied as maintenance immunosuppression.Acute allograft rejection was monitoring.Results Both recipients survived after transplantation.Mild allograft rejection was detected.Two recipients recovered well with pulmonary vital capacity up to 1 700～2 000 mL and discharged two months after transplantation.The 14 months and 8 months follow-up periods,the recipients have a good quality of life.Conclusion Induction with intravenous daclizumab to prevent acute rejection in lung allotransplantation is effective.