Abstract：
:Despite significant progress in the field of transplant immunology, acute cellular rejection (ACR) remains a very frequent complication after lung transplantation (LTx), with almost 30% of LTx recipients experiencing at least one episode of treated ACR during the first year of follow-up. Most episodes respond to the first-line immunosuppressive treatment and are rarely a direct cause of death. However, the association of ACR with later adverse outcomes, such as chronic lung allograft dysfunction, bronchial stricture, and infectious complications associated with the intensification of immunosuppression, negatively impacts long-term survival. The burden imposed on patients and health-care resources is even higher in cases of refractory or recurrent ACR, which accelerates lung function decline. Although important laboratory and clinical research conducted over the last two decades has improved our understanding of the mechanisms underlying ACR, there are still many uncertainties about the risk factors for ACR, the optimal monitoring strategies, and the prediction of long-term outcomes. These knowledge gaps contribute to the large variability in clinical practice among LTx centers, which renders multicenter studies of ACR challenging. In this review, we summarize current evidence on the epidemiology, pathogenesis, and risk factors of ACR. We describe diagnostic and therapeutic approaches that are currently used in the clinical practice and also review promising diagnostic tools that are under investigation. Associations between ACR and other adverse outcomes of LTx are examined. Finally, within each topic of discussion, we highlight the main areas of controversy and opportunities for future research.
journal_name
Semin Respir Crit Care Medjournal_title
Seminars in respiratory and critical care medicineauthors
Koutsokera A,Levy L,Pal P,Orchanian-Cheff A,Martinu Tdoi
10.1055/s-0037-1617424subject
Has Abstractpub_date
2018-04-01 00:00:00pages
181-198issue
2eissn
1069-3424issn
1098-9048journal_volume
39pub_type
杂志文章,评审abstract：:Lung transplantation is a therapeutic option for patients with end stage lung diseases, but long-term survival remains poor, primarily due to chronic allograft rejection. Bronchiolitis obliterans (BO), a fibrotic process resulting in progressive narrowing of bronchiolar lumens and airflow obstruction, is a manifestati...
journal_title：Seminars in respiratory and critical care medicine
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doi：10.1055/s-2004-815601
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abstract：:Mycobacterium avium complex (MAC) is the most commonly isolated nontuberculous mycobacterial respiratory pathogen worldwide. MAC lung disease is manifested either by fibrocavitary radiographic changes similar to pulmonary tuberculosis or by bronchiectasis with nodular and reticulonodular radiographic changes. This lat...
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journal_title：Seminars in respiratory and critical care medicine
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abstract：:Lung cancer is the leading cause of cancer death in the world. However, there is large geographic variation internationally and within nations. Despite the fact that many causes of lung cancer have been established, cigarette smoking is the principal cause. Accounting for historical prevalence of cigarette smoking is ...
journal_title：Seminars in respiratory and critical care medicine
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abstract：:Invasive candidiasis (IC) is the most frequent health care associated invasive fungal infection. It is also associated with high morbidity, mortality, and cost. The most frequent etiologic agent is Candida albicans, but non-albicans species are increasing and associated with reduced antifungal susceptibility and outbr...
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abstract：:Hematologic factors, in particular platelets and the coagulation system, play an important role in the pathogenesis of organ failure in the intensive care unit. Failure of these hematologic systems is common in intensive care patients and may range from isolated thrombocytopenia or prolonged global clotting tests to c...
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abstract：:Pseudomonas aeruginosa is a formidable pathogen in the infection arena. It is able to easily adapt to the environment which it inhabits and can also colonize and invade the human host to cause serious infections. In 2011, it was responsible for 7.1% of all health care-associated infection in the United States. The mor...
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journal_title：Seminars in respiratory and critical care medicine
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doi：10.1055/s-2004-815670
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abstract：:Venous thromboembolism (VTE) is a frequent complication in surgical patients, with the potential for long-term disability or fatal outcome. The rationale behind routine use of thromboprophylaxis can be summarized in three points: (1) VTE is frequent in certain surgical populations, (2) VTE may be fatal, (3) thrombopro...
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journal_title：Seminars in respiratory and critical care medicine
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更新日期：2014-04-01 00:00:00
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pub_type： 杂志文章,评审
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journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章,评审
doi：10.1055/s-2007-970331
更新日期：2007-02-01 00:00:00
abstract：:The evolution of scientific investigation in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is replete with examples of effective bench-to-bedside transitions, pioneering research methodology, and international collaboration. This article highlights for clinicians a selection of challenges and ...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章
doi：10.1055/s-0033-1351120
更新日期：2013-08-01 00:00:00
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journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章,评审
doi：10.1055/s-0037-1602244
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journal_title：Seminars in respiratory and critical care medicine
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doi：10.1055/s-2001-18426
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journal_title：Seminars in respiratory and critical care medicine
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journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章,评审
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journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章,评审
doi：10.1055/s-0032-1311796
更新日期：2012-04-01 00:00:00
abstract：:Nonspecific interstitial pneumonia (NSIP) represents one histologic subtype of idiopathic interstitial pneumonia (IIP). NSIP is typified by temporal homogeneity and less profusion of fibroblastic foci than is seen with usual interstitial pneumonia (UIP), the most common IIP. Clinically patients with NSIP present with ...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章
doi：10.1055/s-2001-17385
更新日期：2001-08-01 00:00:00
abstract：:This article discusses the pleural effusions that occur with the post-cardiac injury (Dressler's) syndrome (PCIS) and those that occur after coronary artery bypass graft (CABG) surgery. The PCIS can occur after any type of cardiac injury and is thought to be due to anti-myocardial antibodies. The primary symptoms are ...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章
doi：10.1055/s-2001-18802
更新日期：2001-12-01 00:00:00
abstract：:Acinetobacter baumannii is a highly resilient, gram-negative coccobacillus that thrives within the unique and complex ecological setting of an intensive care unit. This evolving pathogen has now surpassed human capacity to create new antimicrobials, and has led physicians into a concerning era for hospital-acquired in...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章,评审
doi：10.1055/s-2007-996413
更新日期：2007-12-01 00:00:00
abstract：:Among immunocompromised individuals, members of the human Herpesviridae family are frequently encountered pathogens. Cytomegalovirus, herpes simplex virus 1 and 2, varicella zoster virus, Epstein-Barr virus, and human herpesvirus-6, -7, and -8 all establish latency after infection and can reactivate during periods of ...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章,评审
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更新日期：2016-08-01 00:00:00
abstract：:Over the past 3 decades, antimicrobial resistance among Streptococcus pneumoniae, the most common cause of community-acquired pneumonia (CAP), has escalated dramatically worldwide. In the late 1970s, strains of pneumococci displaying resistance to penicillin were described in South Africa and Spain. By the early 1990s...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章,评审
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更新日期：2009-04-01 00:00:00
abstract：:Despite recent advances in understanding, the management of acute respiratory distress syndrome (ARDS) remains a challenging clinical problem. Optimization of gas exchange and preventing the iatrogenic propagation of lung injury are cornerstones of its clinical management. A number of novel approaches and adjuncts to ...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章
doi：10.1055/s-2001-15785
更新日期：2001-06-01 00:00:00
abstract：:Nonspecific interstitial pneumonia (NSIP) is a complex disorder commonly associated with other conditions such as connective tissue diseases (CTDs) and environmental exposures. Although idiopathic NSIP has been recognized as a separate clinical entity, recent studies have suggested that a proportion of these cases hav...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章
doi：10.1055/s-0040-1708499
更新日期：2020-04-01 00:00:00
abstract：:Hyperoxia, or excess oxygen supplementation, prevails in the intensive care unit (ICU) without a beneficial effect and, in some instances, may cause harm. Recent interest and surge in clinical studies in mechanically ventilated critically ill patients has brought this to the attention of clinicians and researchers. Hy...
journal_title：Seminars in respiratory and critical care medicine
pub_type： 杂志文章,评审
doi：10.1055/s-0035-1570359
更新日期：2016-02-01 00:00:00
