Lymphocyte Subset Populations in Bronchiolitis Obliterans After Heart-Lung Transplantation

Holland, V. A.; Cagle, Philip T.; Windsor, Nancy T.; Noon, George P.; Greenberg, S. Donald; Lawrence, E. Clinton

doi:10.1097/00007890-199012000-00011

Cited by 24 publications

(5 citation statements)

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“…DiGiovine and coworkers included patients without histologic evidence of OB as well and thereby probably found only trends toward the same direction. Holland and coworkers (27) reported increased lymphocyte counts in BALF of OB patients, in particular CD8 + lymphocytes. In our study, lymphocyte counts were increased in the bronchial fraction, but not in the alveolar fraction.…”

Section: Discussionmentioning

confidence: 98%

Eosinophilic Granulocytes and Interleukin-6 Level in Bronchoalveolar Lavage Fluid Are Associated with the Development of Obliterative Bronchiolitis after Lung Transplantation

Scholma

Slebos

Boezen

et al. 2000

Am J Respir Crit Care Med

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In a prospective cohort study, we assessed whether changes in total cell counts and differentiation and interleukin-6 (IL-6), IL-8, and monocyte chemoattractant protein-1 (MCP-1) concentrations in bronchoalveolar lavage fluid (BALF) are associated with a higher risk to develop obliterative bronchiolitis (OB). We investigated 60 lung transplant patients (follow-up of 2 to 8 yr) with either histologic evidence of OB within 1 yr after lung transplantation (n = 19) or no pathology, good outcome (GO) for at least 24 mo and well-preserved lung function, i.e., FEV > or = 80% of baseline (n = 41). Median time between lung transplantation and the first BAL was 42 d for the GO group and 41 d for the OB group (p > 0.05). In the bronchial fraction, median total cell counts (0.06 x 10(3)/ml versus 0.04 x 10(3)/ml), lymphocyte (9 x 10(3)/ml versus 2 x 10(3)/ml), and eosinophilic granulocyte counts (1 x 10(3)/ml versus 0) were significantly higher in the OB group than in the GO group (p < 0.05). In the alveolar fraction, this was the case for the median value of neutrophilic granulocyte counts (19 x 10(3)/ml versus 4 x 10(3)/ml), respectively. Median values of IL-6 and IL-8 concentrations in both bronchial (IL-6: 23 versus 6 pg/ml, IL-8: 744 versus 102 pg/ml) and alveolar fractions (IL-6: 13 versus 3 pg/ml, IL-8: 110 versus 30 pg/ml) of the BALF were significantly higher in the OB group than in the GO group. By means of logistic regression, we showed that higher total cell, neutrophilic granulocyte, and lymphocyte counts, the presence of eosinophilic granulocytes, and higher concentrations of IL-6 and IL-8 were significantly associated with an increased risk to develop OB. We conclude that monitoring cell counts, neutrophilic and eosinophilic granulocytes, IL-6, and IL-8 in BALF within 2 mo after lung transplantation in addition to the transbronchial lung biopsy (TBB) pathology will contribute to a better identification and management of the group of patients at risk for developing OB within a year.

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Section: Discussionmentioning

confidence: 98%

Eosinophilic Granulocytes and Interleukin-6 Level in Bronchoalveolar Lavage Fluid Are Associated with the Development of Obliterative Bronchiolitis after Lung Transplantation

Scholma

Slebos

Boezen

et al. 2000

Am J Respir Crit Care Med

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“…The pathogenesis of CBO is unclear, but major histocompatibility complex class-II antigen expression on bronchial epithelium along with autoantigen presentation and subsequent T-cell activation and inflammation may play a role [5].…”

Section: Discussionmentioning

confidence: 99%

Severe breathlessness, mouth ulcers and skin blistering in a female

Gudi

Ormerod²,

Weir³

et al. 2004

Eur Respir J

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“…Compared to the BAL cell profile of healthy individuals, the cell profile during obliterative bronchiolitis shows significant granulocytosis and a relative decrease of alveolar macrophages (88). The cell distribution in BAL is composed of 40-70% alveolar macrophages, 10-30% lymphocytes and 20-30% neutrophilic granulocytes (86,91,(101)(102)(103). As demonstrated by Devouassoux et al, there is a correlation between the cell profile in BAL and the histologic grade of chronic rejection.…”

Section: Uncomplicated Course After Lung Transplantationmentioning

confidence: 99%

“…Due to high variability, the CD4/CD8 ratio can be elevated, normal or lowered. Holland et al found 48% CD8 positive lymphocytes and 9.4% CD4 positive lymphocytes in BAL of lung transplant recipients with histologically proven bronchiolitis obliterans, resulting in a CD4/CD8 ratio of 0.19 (102). In contrast, Griffith et al showed a CD4/CD8 ratio of 1.8 in patients with histologically proven bronchiolitis obliterans (101).…”

Section: Pulmonary Complicationsmentioning

confidence: 99%

Bronchoalveolar lavage in lung transplantation

Tiroke

Bewig

Haverich

1999

Clinical Transplantation

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Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) has become a crucial tool in the management of lung transplant recipients. Detection of pulmonary infectious pathogens by culture, cytology, and histology of BAL, protected brush specimens, and transbronchial biopsies (TBB) is highly effective. Morphologic and phenotypological analyses of BAL cells may be suggestive for certain complications after lung transplantation. For interpretation of BAL findings, the natural course of BAL cell morphology and phenotypology after lung transplantation must be considered. During the first 3 months after pulmonary transplantation, elevated total cell count in BAL and neutrophilic alveolitis are common, representing the cellular response to graft injury and interaction of immunocompetent cells of donor and recipient origin. With increasing time after transplantation the CD4/CD8 ratio decreases due to lowered percentages of CD4 cells in BAL. During bacterial pneumonias, the cellular profile of BAL is characterized by a marked granulocytic alveolitis. Lymphocytic alveolitis with a decreased CD4/CD8 ratio is suggestive of acute rejection, but is also found in viral pneumonias and obliterative bronchiolitis. In the case of a combined lymphocytosis and neutrophilia without any evidence of infection, obliterative bronchiolitis should be considered. Functional analyses of BAL cells can give additional information about the immunologic status of the graft, even before histologic changes become evident but have not been established in routine transplant monitoring. However, functional studies suggest an important role of activated, alloreactive and donor-specific T lymphocytes in the pathogenesis of acute and chronic lung rejection. Investigations of soluble components in BAL have given further insight into the immunologic processes after lung transplantation. In this overview, the characteristics of BAL after lung transplantation will be summarized, and its relevance for the detection of pulmonary complications will be discussed.

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Lymphocyte Subset Populations in Bronchiolitis Obliterans After Heart-Lung Transplantation

Cited by 24 publications

References 0 publications

Eosinophilic Granulocytes and Interleukin-6 Level in Bronchoalveolar Lavage Fluid Are Associated with the Development of Obliterative Bronchiolitis after Lung Transplantation

Eosinophilic Granulocytes and Interleukin-6 Level in Bronchoalveolar Lavage Fluid Are Associated with the Development of Obliterative Bronchiolitis after Lung Transplantation

Severe breathlessness, mouth ulcers and skin blistering in a female

Bronchoalveolar lavage in lung transplantation

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