留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

移植肺病理学诊断标准及其进展

郭晖

郭晖. 移植肺病理学诊断标准及其进展[J]. 器官移植, 2022, 13(1): 19-31. doi: 10.3969/j.issn.1674-7445.2022.01.004
引用本文: 郭晖. 移植肺病理学诊断标准及其进展[J]. 器官移植, 2022, 13(1): 19-31. doi: 10.3969/j.issn.1674-7445.2022.01.004
Guo Hui. Diagnostic criteria and research progress on lung allograft pathology[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 19-31. doi: 10.3969/j.issn.1674-7445.2022.01.004
Citation: Guo Hui. Diagnostic criteria and research progress on lung allograft pathology[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 19-31. doi: 10.3969/j.issn.1674-7445.2022.01.004

移植肺病理学诊断标准及其进展

doi: 10.3969/j.issn.1674-7445.2022.01.004
基金项目: 

中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助 2019PT320014

详细信息
    通讯作者:

    郭晖,E-mail: zcguo@tjh.tjmu.edu.cn

  • 中图分类号: R617, R36

Diagnostic criteria and research progress on lung allograft pathology

More Information
  • 摘要: 近年来,随着肺移植外科技术和术后管理经验的积累,我国肺移植例数逐步增长。肺移植术后移植肺可出现多种并发症,主要包括由移植肺缺血-再灌注损伤(IRI)等所致的原发性移植肺无功能(PGD)、急性与慢性排斥反应以及移植术后应用免疫抑制剂所致机体免疫力下降出现的机会性感染或淋巴组织异常增生等。移植肺并发症的确诊主要依据移植肺活组织检查(活检)。本文对移植肺病理学研究的简史、移植肺活检的主要方法及其病理学处理技术、肺移植术后主要并发症及其活检病理学诊断标准进行阐述,旨在为指导临床对上述并发症采取针对性的治疗方案提供参考。

     

  • 图  1  移植肺IRI的病理学表现

    注:A图示肺泡腔内大量脱落的肺泡上皮细胞(箭头所示)(HE,×400);B图示移植肺肺泡表面透明膜形成(箭头所示)(HE,×200)。

    Figure  1.  Pathological findings of IRI in lung allograft

    图  2  移植肺A2级ACR的病理学表现

    注:图示小动脉分支内皮上炎症细胞浸润(箭头所示)及局部内膜水肿(星号所示)(HE,×400)。

    Figure  2.  Pathological findings of A2 grade ACR in lung allograft

    图  3  移植肺B1R级淋巴细胞性支气管炎的病理学表现

    注:图示细支气管黏膜上皮层内散在炎症细胞浸润(箭头所示)(HE,×1 000)。

    Figure  3.  Pathological findings of B1R grade lymphocytic bronchitis in lung allograft

    图  4  移植肺慢性排斥反应的OB的病理学表现

    注:图示细支气管管腔大部分为增生的纤维组织阻塞(星号所示)(HE,×400)。

    Figure  4.  Pathological findings of OB of chronic rejection in lung allograft

    图  5  移植肺慢性排斥反应的TAV的病理学表现

    注:图示移植肺内小动脉内膜显著增生增厚(箭头所示)致管腔明显狭窄(HE,×200)。

    Figure  5.  Pathological findings of TAV of chronic rejection in lung allograft

    图  6  移植肺毛霉菌感染的病理学表现

    注:图示移植肺活检组织内毛霉菌菌丝及孢子(Masson,×400)。

    Figure  6.  Pathological findings of mucor infection in lung allograft

    表  1  肺移植术后主要并发症

    Table  1.   Major complications after lung transplantation

    术后时间 并发症类型
    围手术期及术后近期
      (术后1个月内)
    血管与气管吻合口并发症、超急性排斥反应、植入反应、IRI或PGD、急性T细胞介导的排斥反应或AMR、感染
    术后中期
      (术后1个月至1年)
    急性T细胞介导的排斥反应或AMR、感染、移植后淋巴组织异常增生、药物毒性反应、通气相关病变
    术后远期
      (术后1年以上)
    急性细胞性排斥反应、急性AMR、感染、慢性支气管性排斥反应或闭塞性细支气管炎、慢性血管性排斥反应或移植相关血管病、限制性移植肺综合征、中性粒细胞性可逆性移植肺功能障碍、移植后淋巴组织异常增生、原发病复发
    下载: 导出CSV

    表  2  移植肺排斥反应诊断标准及其分级(2007年ISHLT标准)

    Table  2.   Diagnostic criteria and classification of rejection of lung allograft (2007 ISHLT working formulation)

    分级 诊断标准
    急性细胞性排斥反应(A级) A0级,无急性排斥反应;A1级,轻微急性排斥反应;A2级,轻度急性排斥反应;A3级,中度急性排斥反应;A4级,重度急性排斥反应
    淋巴细胞性支气管炎(B级) BX级,活检标本偏少或标本挤压等无法满足诊断;B0级,无淋巴细胞性支气管炎;B1R级,低级别的淋巴细胞性支气管炎;B2R级,高级别的淋巴细胞性支气管炎
    慢性支气管性排斥反应(OB)(C级) C0级,无OB改变;C1级,有OB改变
    慢性血管性排斥反应(TAV)(D级) D0级,无TAV病变;D1级,有TAV病变
    下载: 导出CSV
  • [1] STEWART S, FISHBEIN MC, SNELL GI, et al. Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection[J]. J Heart Lung Transplant, 2007, 26(12): 1229-1242. DOI: 10.1016/j.healun.2007.10.017.
    [2] 胡春晓, 李小杉, 卫栋, 等. 前进中的肺移植事业——我国肺移植发展现状及未来[J]. 器官移植, 2020, 11(2): 204-207. DOI: 10.3969/j.issn.1674-7445.2020.02.005.

    HU CX, LI XS, WEI D, et al. The development of lung transplantation: current situation and future of lung transplantation in China[J]. Organ Transplant, 2020, 11(2): 204-207. DOI: 10.3969/j.issn.1674-7445.2020.02.005.
    [3] 陈实, 郭晖. 移植病理学[M]. 北京: 人民卫生出版社, 2009.
    [4] 朱艳红, 陈静瑜, 杨国仪, 等. 纤维支气管镜肺活检对肺移植术后急慢性排斥的诊断价值[J]. 中国危重病急救医学, 2009, 21(2): 119-120. DOI: 10.3760/cma.j.issn.1003-0603.2009.02.021.

    ZHU YH, CHEN JY, YANG GY, et al. Diagnostic value of transbronchial lung biopsies for acute and chronic rejection in lung transplant recipients[J]. Chin Crit Care Med, 2009, 21(2): 119-120. DOI: 10.3760/cma.j.issn.1003-0603.2009.02.021.
    [5] CAVAZZA A, COLBY TV, DUBINI A, et al. Transbronchial cryobiopsy in the diagnosis of diffuse lung disease[J]. Surg Pathol Clin, 2020, 13(1): 197-208. DOI: 10.1016/j.path.2019.11.004.
    [6] MALDONADO F, DANOFF SK, WELLS AU, et al. Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: chest guideline and expert panel report[J]. Chest, 2020, 157(4): 1030-1042. DOI: 10.1016/j.chest.2019.10.048.
    [7] 中华医学会呼吸病学分会介入呼吸病学学组, 中国医师协会呼吸医师分会介入呼吸病学工作委员会. 经支气管冷冻活检技术临床应用专家共识[J]. 中华结核和呼吸杂志, 2019, 42(6): 405-412. DOI: 10.3760/cma.j.issn.1001-0939.2019.06.002.

    Interventional Respiratory Medicine Group of Respiratory Medicine Branch of Chinese Medical Association, Interventional Respiratory Medicine Working Committee of Respiratory Physician Branch of Chinese Medical Doctor Association. Expert consensus on clinical application of transbronchial cryobiopsy[J]. Chin J Tuberc Respir Dis, 2019, 42(6): 405-412. DOI: 10.3760/cma.j.issn.1001-0939.2019.06.002.
    [8] FROST AE, JAMMAL CT, CAGLE PT. Hyperacute rejection following lung transplantation[J]. Chest, 1996, 110(2): 559-562. DOI: 10.1378/chest.110.2.559.
    [9] SCORNIK JC, ZANDER DS, BAZ MA, et al. Susceptibility of lung transplants to preformed donor-specific HLA antibodies as detected by flow cytometry[J]. Transplantation, 1999, 68(10): 1542-1546. DOI: 10.1097/00007890-199911270-00018.
    [10] BITTNER HB, DUNITZ J, HERTZ M, et al. Hyperacute rejection in single lung transplantation--case report of successful management by means of plasmapheresis and antithymocyte globulin treatment[J]. Transplantation, 2001, 71(5): 649-651. DOI: 10.1097/00007890-200103150-00012.
    [11] MASSON E, STERN M, CHABOD J, et al. Hyperacute rejection after lung transplantation caused by undetected low-titer anti-HLA antibodies[J]. J Heart Lung Transplant, 2007, 26(6): 642-645. DOI: 10.1016/j.healun.2007.03.007.
    [12] DE JESUS PEIXOTO CAMARGO J, MARCANTONIO CAMARGO S, MARCELO SCHIO S, et al. Hyperacute rejection after single lung transplantation: a case report[J]. Transplant Proc, 2008, 40(3): 867-869. DOI: 10.1016/j.transproceed.2008.02.052.
    [13] CAMPO-CAÑAVERAL DE LA CRUZ JL, NARANJO JM, SALAS C, et al. Fulminant hyperacute rejection after unilateral lung transplantation[J]. Eur J Cardiothorac Surg, 2012, 42(2): 373-375. DOI: 10.1093/ejcts/ezs066.
    [14] DIAMOND JM, PORTEOUS MK, ROBERTS LJ 2ND, et al. The relationship between plasma lipid peroxidation products and primary graft dysfunction after lung transplantation is modified by donor smoking and reperfusion hyperoxia[J]. J Heart Lung Transplant, 2016, 35(4): 500-507. DOI: 10.1016/j.healun.2015.12.012.
    [15] NATALINI JG, DIAMOND JM, PORTEOUS MK, et al. Risk of primary graft dysfunction following lung transplantation in selected adults with connective tissue disease-associated interstitial lung disease[J]. J Heart Lung Transplant, 2021, 40(5): 351-358. DOI: 10.1016/j.healun.2021.01.1391.
    [16] LEVINE DJ, GLANVILLE AR, ABOYOUN C, et al. Antibody-mediated rejection of the lung: a consensus report of the International Society for Heart and Lung Transplantation[J]. J Heart Lung Transplant, 2016, 35(4): 397-406. DOI: 10.1016/j.healun.2016.01.1223.
    [17] ROUX A, BENDIB LE LAN I, HOLIFANJANIAINA S, et al. Antibody-mediated rejection in lung transplantation: clinical outcomes and donor-specific antibody characteristics[J]. Am J Transplant, 2016, 16(4): 1216-1228. DOI: 10.1111/ajt.13589.
    [18] ROUX A, THOMAS KA, SAGE E, et al. Donor-specific HLA antibody-mediated complement activation is a significant indicator of antibody-mediated rejection and poor long-term graft outcome during lung transplantation: a single center cohort study[J]. Transpl Int, 2018, 31(7): 761-772. DOI: 10.1111/tri.13149.
    [19] BERY AI, HACHEM RR. Antibody-mediated rejection after lung transplantation[J]. Ann Transl Med, 2020, 8(6): 411. DOI: 10.21037/atm.2019.11.86.
    [20] HACHEM RR. The role of the immune system in lung transplantation: towards improved long-term results[J]. J Thorac Dis, 2019, 11(Suppl 14): S1721-S1731. DOI: 10.21037/jtd.2019.04.25.
    [21] WALLACE WD, LI N, ANDERSEN CB, et al. Banff study of pathologic changes in lung allograft biopsy specimens with donor-specific antibodies[J]. J Heart Lung Transplant, 2016, 35(1): 40-48. DOI: 10.1016/j.healun.2015.08.021.
    [22] GLANVILLE AR, VERLEDEN GM, TODD JL, et al. Chronic lung allograft dysfunction: definition and update of restrictive allograft syndrome-a consensus report from the Pulmonary Council of the ISHLT[J]. J Heart Lung Transplant, 2019, 38(5): 483-492. DOI: 10.1016/j.healun.2019.03.008.
    [23] YOSHIYASU N, SATO M. Chronic lung allograft dysfunction post-lung transplantation: the era of bronchiolitis obliterans syndrome and restrictive allograft syndrome[J]. World J Transplant, 2020, 10(5): 104-116. DOI: 10.5500/wjt.v10.i5.104.
    [24] ONISHI Y, KAWAMURA T, HIGASHINO T, et al. Clinical features of acute fibrinous and organizing pneumonia: an early histologic pattern of various acute inflammatory lung diseases[J]. PLoS One, 2021, 16(4): e0249300. DOI: 10.1371/journal.pone.0249300.
    [25] YATES B, MURPHY DM, FORREST IA, et al. Azithromycin reverses airflow obstruction in established bronchiolitis obliterans syndrome[J]. Am J Respir Crit Care Med, 2005, 172(6): 772-775. DOI: 10.1164/rccm.200411-1537OC.
    [26] VERLEDEN SE, VANDERMEULEN E, RUTTENS D, et al. Neutrophilic reversible allograft dysfunction (NRAD) and restrictive allograft syndrome (RAS)[J]. Semin Respir Crit Care Med, 2013, 34(3): 352-360. DOI: 10.1055/s-0033-1348463.
    [27] TODD JL, KELLY FL, NAGLER A, et al. Amphiregulin contributes to airway remodeling in chronic allograft dysfunction after lung transplantation[J]. Am J Transplant, 2020, 20(3): 825-833. DOI: 10.1111/ajt.15667.
    [28] SACREAS A, TAUPIN JL, EMONDS MP, et al. Intragraft donor-specific anti-HLA antibodies in phenotypes of chronic lung allograft dysfunction[J]. Eur Respir J, 2019, 54(5): 1900847. DOI: 10.1183/13993003.00847-2019.
    [29] LOOR K, PALLISA E, CULEBRAS M, et al. New opacities in lung allograft after transbronchial cryobiopsy[J]. Respir Med, 2020, 170: 106043. DOI: 10.1016/j.rmed.2020.106043.
    [30] VANSTAPEL A, GOLDSCHMEDING R, BROEKHUIZEN R, et al. Connective tissue growth factor is overexpressed in explant lung tissue and broncho-alveolar lavage in transplant-related pulmonary fibrosis[J]. Front Immunol, 2021, 12: 661761. DOI: 10.3389/fimmu.2021.661761.
    [31] WEIGT SS, WANG X, PALCHEVSKIY V, et al. Usefulness of gene expression profiling of bronchoalveolar lavage cells in acute lung allograft rejection[J]. J Heart Lung Transplant, 2019, 38(8): 845-855. DOI: 10.1016/j.healun.2019.05.001.
    [32] KOUTSOKERA A. Rethinking bronchoalveolar lavage in acute cellular rejection: how golden is the standard of transbronchial biopsies?[J]. J Heart Lung Transplant, 2019, 38(8): 856-857. DOI: 10.1016/j.healun.2019.06.016.
  • 加载中
图(7) / 表(2)
计量
  • 文章访问数:  246
  • HTML全文浏览量:  91
  • PDF下载量:  54
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-11-23
  • 网络出版日期:  2022-01-12
  • 刊出日期:  2022-01-15

目录

    /

    返回文章
    返回