Transplantations of lungs in the Czech Republic – from the perspective of the pathologist

Česká verzia

Authors: Mária Chadimová ¹; Daniela Kodetová ¹; Robert Lischke ²; Jan Šimonek ²; Jiří Pozniak ²; Pavel Pafko ²
Authors place of work: Ústav patologie a molekulární medicíny 2. LF UK a FN Motol, Praha ¹; 3. chirurgická klinika 1. LF UK a FN Motol, Praha ²
Published in the journal: Čes.-slov. Patol., 51, 2015, No. 4, p. 175-180
Category: Reviews Article

Summary

Lung transplantation has become a standard therapeutic procedure for patients with end-stage pulmonary diseases in the Czech Republic. There were 246 lung transplantations performed from December 1997 to the end of November 2014 at the 3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague and Motol University Hospital. The most common indications for transplantation were chronic obstructive pulmonary disease in 39.4 % of patients, idiopathic pulmonary fibrosis in 28.9 % of patients and cystic fibrosis in 19.1 % of patients. The trans-bronchial biopsy is important for monitoring patients after lung transplantation. The biopsy helps to detect acute cellular rejection, which was found within 63 % of our patients. Patients with the mild and moderate grade of acute cellular rejection got better after the anti-rejection therapy. The severe rejection in three patients led to the shock change in lung and to respiratory failure. Humoral rejection cannot be determined based on biopsy only - the capillaritis and the linear binding of C4d fraction of the complement to the capillaries are inconsistent findings and are not pathognomonic. The classification of chronic rejection, which corresponds to the bronchiolitis obliterans, is limited for the common absence of bronchioli in the biopsy. Therefore, bronchiolitis obliterans in our study group was detected in only 3.7 % of patients.

Since the first transplantation, 109 of our patients have survived (44.3 %). After transplantation about 90 % of patients live one year, about 70.9 % of patients live 3 years and 69.1 % live 5 years. An autopsy at our department was performed in 79 cases. The most common causes of death were mycotic infections (aspergillosis, candidiasis), bacterial infections (Klebsiela, Pseudomonas aeruginosa, Burkholderia cepacia) followed by sepsis and viral infection (CMV, varicella zoster). At the autopsy, chronic rejection was found in 13 patients and it led to chronic respiratory failure, which was often complicated by an infection. The tumors as the cause of death were mostly generalized carcinomas.

Keywords:
lungs transplantation – acute rejection – humoral rejection – chronic rejection – infections – tumors

Zdroje

1. Hardy J, Webb W, Dalton M, et al. Lung homotransplantations in man. J Am Assoc 1963; 186: 1065-1074.

2. Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med 1986; 314(18): 1140-1145.

3. Steen S, Sjoberg T, Pierre L, et al. Transplantation of lung from a non-heart-beating donor. Lancet 2001; 357(9259): 825-829.

4. Pafko P, Kabát J, Schűtzner J, et al. První transplantace plic v České republice. Rozhl Chir 1999; 78(4): 148-149.

5. Pafko P, Schűtzner J, Lischke R, et al. The first sequential transplantation of both lungs in the Czech Republic. Rozhl Chir 1999; 78(5): 235-236.

6. Lischke R, Šimonek J, Pozniak J, et al. Transplantace plic. Rozhl Chir 2011; 90(11): 612-620.

7. Treede H, Glanville AR, Klepetko W, et al. Tacrolimus and cyclosporine have differential effects on the risk of development of bronchiolitis obliterans syndrome: results of a prospective, randomized international trial in lung transplantation. J Heart Lung Transpl 2012; 31(8): 797-804.

8. Sundaresan S, Mohanakumar T, Smith MA, et al. HLA-A locus mismatches and development of antibodies to HLA after lung transplantation correlate with the development of bronchiolitis obliterans syndrome. Transplantation 1998; 65(5): 648-653.

9. Hachem PR. Antibodies to human leukocyte antigens in lung transplantation. Clin Transpl 2011: 327-332.

10. Morrel MR, Pilewski JM, Gries CJ, et al. De novo donor-specific HLA antibodies are associated with early and high-grade bronchiolitis obliterans syndrome and death after lung transplantation. J Heart Lung Transpl 2014; 33(12): 1288-1294.

11. Yousem S. A perspective on the revised working formulation for the grading lung allograft rejection. Transpl Proc 1996; 28(1): 477-479.

12. De Blic J, Peuchmaur M, Carnot F, et al. Rejection in lung transplantation-an immunohistochemical study of transbronchial biopsies. Transplantation 1992; 54(4): 639-644.

13. Estenne M, Maurer JR, Boehler A, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant 2002; 21(3): 297-310.

14. 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 Heart Lung Transpl 2007; 26(12): 1229-1242.

15. Ramsey H. Antibody-mediated lung transplant rejection. Curr Respir Care Rep 2012; 1(3): 157-161.

16. Haas M, Sis B, Racusen LC, et al. Banff 2013 meeting report: Inclusion of C4d-negative antibody-mediated rejection and antibody associated arterial lesions. Am J Transpl 2014; 14: 272-283.

17. Salvadori M, Bertoni E: What´s new in clinical solid organ transplantation by 2013. World J Transplant 2014; 4(4): 243-266.

18. Lefaucheur C, Nochy D, Andrade J, et al. Comparison of combination plasmapheresis/IVIG/anti-CD20 versus high-dose IVIG in the treatment of antibody-mediated rejection. Am J Transplant 2009; 9: 1099-1107.

19. Khalifah AP, HachemRR, Chakinala MM, et al. Respiratory viral infection are a distinct risk for bronchiolitis obliterans syndrome and death. Am J Respir Crit Care Med 2004; 170(2): 181-187.

20. Trofe J, Beebe TM, Buell JF et al. Posttransplant malignancy. Progress in Transplantation 2004; 14(3): 193-200.

21. Olland BM, Falcoz PE, Santelmo N, et al. Primary lung cancer in lung transplant recipients. Ann Thorac Surg 2014; 98: 362-371.

22. Whitson BA, Hayes D Jr. Indications and outcomes in adult lung transplantation. J Thorac Dis 2014; 6(8): 1018-1023.

23. Kistler KD, Nalysnyk L, Rotella P, et al. Lung transplantation in idiopathic pulmonary fibrosis: a systematic review of the literature. BMC Pulm Med 2014; 14: 139.

24. McManigle W, Pavlisko EN, Martinu T. Acute cellular and antibody-mediated allograft rejection. Semin Respir Crit Care Med 2013; 34(3): 320-335.

25. Westall GP, Snell GI. Antibody-mediated rejection in lung transplantation: fable, spin, or fact? Transplantation 2014; 98: 927-930.

26. Kirkby S, Hayes Jr D. Pediatric lung transplantation: indications and outcomes. J Thorac Dis 2014; 6(8): 1024-1031.