A novel approach to the assessment of lymphocytic bronchiolitis after lung transplantation-transbronchial brush
Date
2011
Authors
Chambers, D.
Hodge, S.
Hodge, G.
Yerkovich, S.
Kermeen, F.
Reynolds, P.
Holmes, M.
Hopkins, P.
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Journal article
Citation
Journal of Heart and Lung Transplantation, 2011; 30(5):544-551
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Daniel C. Chambers, Sandra Hodge, Greg Hodge, Stehanie T. Yerkovich, Fiona D. Kermeen, Paul Reynolds, Mark Holmes and Peter M.A. Hopkins
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Abstract
<h4>Background</h4>Lymphocytic bronchiolitis (LB) is the strongest risk factor for subsequent allograft loss due to bronchiolitis obliterative syndrome (BOS); however, it is poorly assessed by transbronchial biopsy (TBBx) because of sampling error, interpretation error and the presence of non-alloimmune airway inflammation. We hypothesized that flow cytometric evaluation of bronchiolar brushings (transbronchial brush, TBBr) may be a better approach.<h4>Methods</h4>Transbronchial brushings (2 to 3 cm from the pleural surface under radiologic guidance) were obtained prior to TBBx in 32 patients and analyzed by flow cytometry. We assessed the proportion of nucleated cells that were CD3(+)CD103(+) (epithelial-specific T cells).<h4>Results</h4>No adverse events occurred; 0.5% (0.27 to 0.84) of the cells were epithelial-specific T cells and numbers increased with episodes of Grade A1 rejection (p < 0.01) and in patients with BOS (p = 0.02). Viral and invasive fungal infection were associated with marked infiltration with CD103(-) T cells (p < 0.01).<h4>Conclusion</h4>TBBr is simple to obtain, low risk, quantitative, and can discriminate between infective and alloimmune LB. It may be a valuable addition to current lung allograft assessment.
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Copyright © 2011 Elsevier B.V.