甲型流感感染后原位心脏移植的细胞和抗体联合介导的排斥反应。

IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL
Joseph Crowder, Jeffrey F Spindel, Nathan Shelman, Vasilios Katsadouros, Andrew Kolodziej
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引用次数: 0

摘要

病毒感染与实体器官移植受者急性同种异体排斥反应有关。流感感染上调宿主促炎细胞因子,提示宿主免疫反应可促成移植物排斥反应。特别地,大流行性流感与多个肾移植受者的排斥反应有关。然而,心脏异体移植排斥反应与流行性流感的关系尚未见报道。我们报告了一例30多岁的男性,5年前移植,在pcr确诊甲型流感感染4周后出现新的心力衰竭。心肌膜活检显示同时存在高度急性细胞排斥反应和抗体介导的排斥反应。尽管移植前的整体反应性抗体为0%,虚拟交叉配伍阴性,且治疗性他克莫司水平一致,但仍产生了新的供体特异性抗体。即使进行了积极的治疗,他还是死于移植物衰竭。移植受者必须定期接种疫苗,临床医生应在流感感染后立即保持对移植失败的高度怀疑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Combined cellular and antibody-mediated rejection of orthotopic heart transplant following influenza A infection.

Viral infections have been associated with acute allograft rejection in solid organ transplant recipients. Influenza infection upregulates host proinflammatory cytokines, suggesting the host immune response can precipitate graft rejection. Pandemic influenza, specifically, was associated with rejection in multiple renal allograft recipients. However, cardiac allograft rejection has not been reported in association with endemic influenza. We present the case of a man in his mid-30s, transplanted 5 years prior, who developed new heart failure 4 weeks after PCR-confirmed influenza A infection. Endomyocardial biopsy revealed concomitant high-grade acute cellular rejection and antibody-mediated rejection. Despite a pretransplant panel reactive antibody of 0%, a negative virtual crossmatch and consistently therapeutic tacrolimus levels, de novo donor-specific antibodies developed. Even with aggressive therapy, he died as a result of graft failure. Transplant recipients must be regularly vaccinated, and clinicians should maintain a high degree of suspicion of graft failure in the immediate aftermath of influenza infection.

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来源期刊
BMJ Case Reports
BMJ Case Reports Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
1588
期刊介绍: BMJ Case Reports is an important educational resource offering a high volume of cases in all disciplines so that healthcare professionals, researchers and others can easily find clinically important information on common and rare conditions. All articles are peer reviewed and copy edited before publication. BMJ Case Reports is not an edition or supplement of the BMJ.
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