Treatment Responses in Histologic Versus Molecular Diagnoses of Lung Rejection

A. Zajacova, M. Mackova, K. Halloran, P. Gauthier, J. Balko, M. Guney, D. Rakita, M. Svorcova, J. Kolařík, J. Vachtenheim, J. Pozniak, J. Simonek, L. Fila, R. Lischke, P. Halloran, J. Havlín
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Abstract

Histologic evaluation of allograft biopsies after lung transplantation has several limitations, suggesting that molecular assessment using tissue transcriptomics could improve biopsy interpretation. This single-center, retrospective cohort study evaluated discrepancies between the histology of transbronchial biopsies (TBBs) with no rejection (NR) and T-cell mediated rejection (TCMR) by molecular diagnosis. The accuracy of diagnosis was assessed based on response to treatment. 54 TBBs from Prague Lung Transplant Program obtained between December 2015 and January 2020 were included. Patients with acute cellular rejection (ACR) grade ≥ 1 by histology received anti-rejection treatment. Response to therapy was defined as an increase in FEV1 of ≥ 10% 4 weeks post-biopsy compared to the pre-biopsy value. Among the 54 analyzed TBBs, 25 (46%) were concordant with histology, while 29 (54%) showed discrepancies. ACR grade 0 was found in 12 TBBs (22%) and grade A1 ≥ 1 in 42 TBBs (78%). Treatment response was present in 14% in the NR group and in 50% in the TCMR group (p = 0.024). Our findings suggest that low-grade acute cellular rejection is less likely to be associated with molecular TCMR, which might better identify lung transplant recipients who benefit from therapy.
肺部排斥的组织学诊断与分子诊断的治疗反应
肺移植后异体活检的组织学评估有一些局限性,这表明利用组织转录组学进行分子评估可以改善活检的解释。这项单中心回顾性队列研究通过分子诊断评估了无排斥反应(NR)和T细胞介导的排斥反应(TCMR)经支气管活检组织学之间的差异。根据治疗反应评估诊断的准确性。纳入了2015年12月至2020年1月期间从布拉格肺移植项目获得的54例TBB。组织学显示急性细胞排斥反应(ACR)分级≥1级的患者接受了抗排斥治疗。对治疗的反应定义为活检后4周FEV1与活检前相比增加≥10%。在分析的54例TBB中,25例(46%)与组织学结果一致,29例(54%)存在差异。12个TBB(22%)的ACR等级为0级,42个TBB(78%)的A1等级≥1级。NR组中有14%出现治疗反应,TCMR组中有50%出现治疗反应(P = 0.024)。我们的研究结果表明,低度急性细胞排斥反应不太可能与分子TCMR相关,这可能会更好地识别从治疗中获益的肺移植受者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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