[Graft dysfunction, acute rejection and bronchiolitis obliterans in lung and heart-lung transplantation].
Three complications which influence both survival and quality of life in transplanted patients will be the object of this chapter. Graft dysfunction: this is a severe re-implantation oedema leading to inefficiency of the graft as regards haemostasis whether or not associated with haemodynamic complications. The liberation of free radicals and/or cytokines induced by ischemia-reperfusion of the graft plays an important role in the pathogenesis of this syndrome. Acute rejection: the mechanism is complex leading to the intervention of an immune response stimulated by the detection of allo-antigens. The clinical picture is often non-specific. Treatment requires boluses of methyl prednisolone completed by decreasing dose of corticosteroid therapy orally. The syndrome of bronchiolitis obliterans: this is a progressive failure of the airways. This syndrome occurs in the long term in 50% of patients and presents with progressive dyspnoea associated with persistent or recurrent cough. The pathogenesis is brought about principally by a chronic rejection with a specific cytotoxic reaction of T lymphocytes against the airway epithelium which expresses Class II major histocompatibility antigens. Attempts at curative treatment can be extremely deceptive and leads to, at best, a slowing in decline of respiratory function.
Sleiman
C
C
Service de Pneumologie et Réanimation, Hôpital Beaujon, Clichy, France.
Groussard
O
O
Mal
H
H
Fournier
M
M
D000208:Acute Disease; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D016207:Cytokines / Q000502:physiology; D004487:Edema / Q000209:etiology / Q000503:physiopathology; D005609:Free Radicals; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D006085:Graft Survival; D016041:Heart-Lung Transplantation / Q000009:adverse effects / Q000276:immunology / Q000502:physiology*; D000949:Histocompatibility Antigens Class II / Q000276:immunology; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D007519:Isoantigens / Q000276:immunology; D016040:Lung Transplantation / Q000009:adverse effects / Q000276:immunology / Q000502:physiology*; D008775:Methylprednisolone / Q000627:therapeutic use; D011788:Quality of Life; D015427:Reperfusion Injury / Q000209:etiology / Q000503:physiopathology; D015996:Survival Rate; D013577:Syndrome; D013601:T-Lymphocytes / Q000276:immunology; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
D000893:Anti-Inflammatory Agents; D016207:Cytokines; D005609:Free Radicals; D005938:Glucocorticoids; D000949:Histocompatibility Antigens Class II; D007519:Isoantigens; D008775:Methylprednisolone