Bronchoalveolar lavage fluid characteristics in acute and chronic lung transplant rejection.

Abstract

BACKGROUND:

The detection of graft rejection by bronchoalveolar lavage remains controversial.

METHODS:

To assess the value of bronchoalveolar lavage fluid in acute and chronic rejection after lung transplantation we analyzed bronchoalveolar lavage fluid cellular differential characteristics, lymphocyte sub-types and interleukin-6 (IL-6) and interleukin-8 (IL-8) cytokine levels in patients with exclusively either acute rejection (n = 37) or bronchiolitis obliterans (BO; n = 48). Both groups were compared with a control group of lung transplantation patients without rejection or infection, matched for the time the lavage was performed after lung transplantation.

RESULTS:

The bronchiolitis obliterans group showed marked neutrophilia, high IL-8 and higher CD4(+)CD25(+) and CD8(+)CD45(+) bronchoalveolar lavage fluid levels when compared with their stable controls. When using a cut-off point of >3% neutrophils in the lavage, the sensitivity for BO is 87.0%, the specificity 77.6%. The sensitivity of IL-8 for BO when using a cut-off point of >71.4 pg/ml is 74.5%, the specificity 83.3%. Bronchoalveolar lavage fluid in acute rejection was characterized by marked lymphocytosis, but showed no difference when compared with stable controls in any of the lymphocyte sub-types studied. When using a cut-off point of <==1% lymphocytes in the lavage, the sensitivity for acute rejection (AR) is 40.4%, the specificity 95.6%. The marked neutrophilia, high IL-8 cytokine level and more activated lymphocyte population in bronchiolitis obliterans may indicate ongoing local allograft rejection.

CONCLUSIONS:

In the present study we were not able to show any difference in lymphocyte sub-types when comparing acute rejection and control subjects. Cellular and soluble parameters in bronchoalveolar lavage fluid appear useful for diagnosing bronchiolitis obliterans.

• Authors: Dirk-Jan Slebos, Dirkje S Postma, Gerard H Koëter, Wim Van Der Bij, Marike Boezen, Henk F Kauffman
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 23 Issue 5 Pg. 532-40 (May 2004) ISSN: 1053-2498 [Print] United States
• PMID: 15135367 (Publication Type: Journal Article)

Chemical References

• Interleukin-6
• Interleukin-8

Topics

• Acute Disease
• Adult
• Bronchiolitis Obliterans (diagnosis, etiology)
• Bronchoalveolar Lavage Fluid (chemistry, cytology)
• Cell Count
• Chronic Disease
• Female
• Flow Cytometry
• Graft Rejection (pathology)
• Humans
• Interleukin-6 (analysis)
• Interleukin-8 (analysis)
• Lung Transplantation
• Lymphocyte Subsets (pathology)
• Male
• Sensitivity and Specificity