Peripheral blood eosinophilia as a marker of acute cellular rejection in lung transplant recipients

Ibáñez, Silvia Aguado; Aguilar, Myriam; Vicente, Ana Royuela; Garcı́a-Gallo, C. López; Nuevo, Gema Díaz; Antón, Clara Salas; Gil, María Piedad Ussetti

doi:10.1016/j.healun.2021.12.007

Cited by 9 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Trull et al [29] described an association between EOS counts > 140 and ACR. We have previously described those patients with ACR showed significantly higher EOS counts than patients without ACR (203.6 ± 248/mm 3 vs. 103.1 ± 153/mm 3 ; p < 0.001), and that the grade of ACR was higher in patients with higher EOS counts [9]. In this previous study, we calculated the AUROC to know the EOS cut-off point.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

A Combination of Cytological Biomarkers as a Guide in the Diagnosis of Acute Rejection in Lung Transplant Recipients

et al. 2023

Self Cite

View full text Add to dashboard Cite

The usefulness of bronchoalveolar lavage fluid (BALF) to support the diagnosis of acute cellular (ACR) rejection in lung transplant (LTX) recipients remains controversial. ACR has been associated with blood eosinophil counts (EOS) in other solid organ recipients, but there are few studies in relation to lung transplants. Our aim was to assess the usefulness of the combined analysis of BALF cellularity and EOS for the diagnosis of ACR in lung transplant recipients. This is a retrospective study of findings observed simultaneously in 887 transbronchial biopsies (TBB), BALF, and blood samples obtained from 363 LTx patients transplanted between 2014 and 2020. The variables collected were: demographics, ACR degree, BALF cellularity, and simultaneous blood EOS counts. The lymphocyte count in BALF was significantly higher in patients with ACR than in those without (11.35% vs. 6.11%; p < 0.001). In parallel, EOS counts were also significantly higher in patients with ACR than in the non-ACR group (EOS 213 ± 206/mm3 vs. 83 ± 129/mm3; p < 0.001). Increases in both parameters were associated with an increased risk of ACR (lymphocytes OR 1.100; 95% CI 1.080–1.131; EOS OR 1.460; 95% CI 1.350–1.580). The diagnostic specificity of ACR for a lymphocyte count > 12% was 71.1%, which increased to 95.8% when taking into account a simultaneous blood EOS count > 200/mm3. Simultaneous assessment of BALF lymphocyte counts and blood eosinophil counts may be useful for diagnosing ACR in patients with risk factors for TBB or in the presence of inconclusive histological samples.

show abstract

Section: Discussionmentioning

confidence: 98%

“…In a previous study at our lung transplant unit, we observed that determining EOS counts in blood could be of use to indicate acute rejection and increase the diagnostic effectiveness of TBB [9].…”

Section: Introductionmentioning

confidence: 99%

A Combination of Cytological Biomarkers as a Guide in the Diagnosis of Acute Rejection in Lung Transplant Recipients

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition to histologic phenotypes, an eosinophilic phenotype of ACR is increasingly being recognized. Both peripheral eosinophilia and eosinophilic alveolitis have been associated with ACR, BAL eosinophilia >/= 1% in the first post-transplant year was also found to be a significant predictor of CLAD [68,69]. Other investigators have also demonstrated an association between BAL or serum eosinophilia with CLAD, and specifically the restrictive allograft syndrome (RAS) phenotype which has a particularly poor prognosis [70,71].…”

Section: Eosinophilic Acrmentioning

confidence: 99%

Acute Rejection of the Lung Allograft: Phenotypes and Management

Menachem,

Hanna,

Kulkarni

et al. 2023

OBM Transplant

View full text Add to dashboard Cite

Treatment options for end stage lung diseases are limited to stabilizing lung failure, decreasing disease progression, and symptom management, but significant reversal of lost lung function is often not possible. For well selected patients, lung transplantation may be a viable option to improve both longevity and quality of life. Though outcomes for lung transplant recipients have improved over several decades, long term survival still lags behind that of other solid organ transplant recipients. Longevity after lung transplantation is limited by chronic lung allograft dysfunction. Numerous insults to the allograft contribute to chronic rejection, alloimmune injuries including acute T-cell mediated and antibody mediated rejection are chief among them. Therefore, monitoring for and management of acute cellular and antibody mediated rejection are of paramount importance to those caring for lung transplant recipients. We provide an up to date and comprehensive review of acute rejection affecting lung allografts and attempt to highlight pathophysiology, risk factors, clinical presentation, rejection phenotypes, management strategies, as well as related from of acute allograft injury.

show abstract

“…In our Lung Transplant Unit, we routinely monitor EOS counts during post-transplant follow-up. In this respect, we recently published a retrospective study of our experience with 583 consecutive fibre-optic bronchoscopies (FBS) with transbronchial biopsy (TBB) and bronchoalveolar lavage (BAL) performed on 256 recipients transplanted between 2012 and 2018 37 . Acute rejection was observed in 170 out of 583 TBB (29.2%).…”

Section: Eosinophils In Peripheral Bloodmentioning

confidence: 99%

Cellular Biomarkers of Rejection in Lung Transplant: The Usefulness of Eosinophil and Lymphocyte Counts

Ussetti,

Aguado,

Laporta

2023

BRN

View full text Add to dashboard Cite

There is increasing interest in the development of biomarkers of acute cellular rejection (ACR) and chronic allograft dysfunction (CLAD) in lung transplant recipients. However, few studies have focused on the predictive value of cellular biomarkers usually available in routine clinical practice such as eosinophils (EOS) and lymphocytes. Peripheral blood eosinophilia has been associated with ACR in kidney, heart and liver transplant recipients. There are few studies in relation to EOS counts in lung transplants. In our experience, the increase in EOS in peripheral blood may be a warning sign of rejection that advises to expand the assessment with a bronchoscopy (FBS), transbronchial biopsy (TBB) and bronchoalveolar lavage (BAL). Lymphocytes are essential cells in the development of ACR. The increase in lymphocytes in the BAL fluid (BALF) may be indicative of ACR, especially if it is associated with a simultaneous increase in the EOS count in the peripheral blood.

show abstract

Peripheral blood eosinophilia as a marker of acute cellular rejection in lung transplant recipients

Cited by 9 publications

References 19 publications

A Combination of Cytological Biomarkers as a Guide in the Diagnosis of Acute Rejection in Lung Transplant Recipients

A Combination of Cytological Biomarkers as a Guide in the Diagnosis of Acute Rejection in Lung Transplant Recipients

Acute Rejection of the Lung Allograft: Phenotypes and Management

Cellular Biomarkers of Rejection in Lung Transplant: The Usefulness of Eosinophil and Lymphocyte Counts

Contact Info

Product

Resources

About