Clinical lung and heart/lung transplantation
Prognostic Value of Bronchoalveolar Lavage Neutrophilia in Stable Lung Transplant Recipients

https://doi.org/10.1016/j.healun.2009.01.014Get rights and content

Background

Bronchoalveolar lavage (BAL) neutrophilia may identify patients prone to develop bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). This study assessed the predictive value of BAL neutrophilia in stable recipients.

Methods

Evaluated were 63 consecutive recipients 3 to 12 months after LTx demonstrating no acute rejection (AR) and lymphocytic bronchitis (LB; B ≤ 1 without infection; BOS, 0). Recipients were subdivided into never-BOS (follow-up ≥ 12 months) and ever-BOS groups (i.e., BOS development ≥ 1 after bronchoscopy).

Results

The groups were statistically indistinguishable for demographic data and preceding AR and LB episodes. Onset of BOS was at a median of 232 days (range, 87–962) after bronchoscopy. The ever-BOS group (16 patients) demonstrated a significantly higher percentage of neutrophils compared with the never-BOS group (47 patients) at the time of bronchoscopy (33.6% ± 2.1% vs 9.9% ± 1.1%, p < 0.05). By Cox regression analysis, a BAL neutrophil percentage of ≥ 20% remained a significant predictor for BOS ≥ 1 (hazard ratio, 3.57; 95% confidence interval, 1.71–8.40, p < 0.05) distinct from known potential BOS predictor variables. The positive and negative predictive value of BAL neutrophilia of ≥ 20% for future BOS was 0.72 and 0.93, respectively (p < 0.05).

Conclusion

BAL neutrophilia in stable recipients is of predictive value to identify recipients at risk for BOS. These data warrant prospective confirmation and further studies to evaluate the benefit of preemptive therapy for potential BOS patients.

Section snippets

Study Design

This study retrospectively evaluated 184 consecutive patients who underwent LTx from January 1996 through December 2007 at the University of Munich. The study was performed in accordance with recommendations of the local board on medical ethics at Ludwig Maximilians University of Munich. Informed written consent was obtained from each patient.

Follow-up data were collected through December 1, 2007. Demographic and clinical data were prospectively obtained from medical records and computerized

Patient Cohorts

From 652 TBBs in 184 patients (median, 3 bronchoscopies/patient; range, 1–9) that were assessed, 469 biopsy specimens (72%) showed no AR (A0), 112 (17%) demonstrated minimal AR (A1), and in 71 (11%) showed AR of A ≥ 2. No evidence of LB (B0) was found in 187 specimens (28%), LB grade B1 was confirmed in 306 (47%), and grade B ≥ 2 in 163 (25%).

Of a total of 184 patients, 63 (34.2%) fulfilled the criteria for stable LTx recipients and were entered in this analysis. Of these, 47 (74.6%) did not

Discussion

Our results demonstrated that in stable LTx recipients, an increased percentage of BAL neutrophils in the absence of confounders constitutes an increased risk for AR and has a predictive value for BOS. Moreover, IL-8 BAL levels were positively and SLPI BAL levels were negatively correlated with the relative number of neutrophils, indicating a potentially important role in the pathogenesis of BOS.

Several studies have investigated the usefulness of BAL analysis in providing information related to

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