Persistent increases of BAL neutrophils as a predictor of mortality following lung transplant - PubMed (original) (raw)
Persistent increases of BAL neutrophils as a predictor of mortality following lung transplant
J A Henke et al. Chest. 1999 Feb.
Abstract
Study objectives: To evaluate whether findings from surveillance bronchoscopy predict survival following lung transplantation.
Design: Retrospective review and analysis of 498 bronchoscopies with transbronchial biopsy (TBB) and BAL performed in 34 patients after lung transplantation.
Setting: University-based, tertiary referral medical center.
Patients: Thirty-four patients after lung transplantation. The mean age at transplantation was 49+/-9 years; 20 (59%) were female. Twenty-four (71%) underwent single and 10 (29%) underwent bilateral lung transplantation. The most common pretransplantation diagnostic groups were emphysema/COPD without concomitant alpha1-antiprotease deficiency (n = 13) and other obstructive disease processes (n = 10).
Interventions: Over follow-up, subjects underwent multiple bronchoscopies with TBB and BAL. The median number per subject was 15 (25 to 75% range 13 to 17).
Measurements and results: We calculated the overall median BAL WBCs and median percent neutrophils (polymorphonuclear leukocytes [PMNs]) among all of the BALs performed for each subject. We then calculated the mean +/- SD of those median values. We used Cox proportionate hazards to assess mortality risk. The median overall follow-up observation period for the cohort was 560 days. There were 11 deaths during this period. Twenty-four subjects (71%) had acute rejection (AR) grades 2 to 4 (mild to severe), and nine (27%) had obliterative bronchiolitis (OB) diagnosed by TBB at any point. The mean value for BAL WBCs was 366+/-145 x 10(3) per milliliter; for percentage PMNs, the mean was 7+/-10%. Adjusting for age, gender, single vs bilateral lung transplantation, pretransplantation diagnostic group, presence of AR, presence of OB, BAL WBC concentration, and lymphocyte CD4/CD8 ratio, PMN percent was a significant predictor of mortality (p = 0.02).
Conclusions: Ongoing inflammation manifested by an increased percentage PMNs over repeated bronchoscopies predicts mortality following lung transplantation. Biopsy data alone may be insufficient to identify posttransplantation patients at risk of poor outcome.
Similar articles
- Single-institution study evaluating the utility of surveillance bronchoscopy after lung transplantation.
Valentine VG, Gupta MR, Weill D, Lombard GA, LaPlace SG, Seoane L, Taylor DE, Dhillon GS. Valentine VG, et al. J Heart Lung Transplant. 2009 Jan;28(1):14-20. doi: 10.1016/j.healun.2008.10.010. Epub 2008 Dec 12. J Heart Lung Transplant. 2009. PMID: 19134525 - Prognostic value of bronchoalveolar lavage neutrophilia in stable lung transplant recipients.
Neurohr C, Huppmann P, Samweber B, Leuschner S, Zimmermann G, Leuchte H, Baumgartner R, Hatz R, Frey L, Ueberfuhr P, Bittmann I, Behr J; Munich Lung Transplant Group. Neurohr C, et al. J Heart Lung Transplant. 2009 May;28(5):468-74. doi: 10.1016/j.healun.2009.01.014. Epub 2009 Mar 14. J Heart Lung Transplant. 2009. PMID: 19416775 - Altered nonspecific lymphocyte cytotoxicity in bronchoalveolar lavage of lung transplant recipients: can it be useful in monitoring rejection or infection?
Shennib H, Lee AG, Serrick C, Giaid A. Shennib H, et al. Transplantation. 1996 Nov 15;62(9):1262-7. doi: 10.1097/00007890-199611150-00015. Transplantation. 1996. PMID: 8932269 - Bronchoalveolar lavage in lung transplantation. State of the art.
Tiroke AH, Bewig B, Haverich A. Tiroke AH, et al. Clin Transplant. 1999 Apr;13(2):131-57. doi: 10.1034/j.1399-0012.1999.130201.x. Clin Transplant. 1999. PMID: 10202611 Review. - Endoscopic monitoring of lung transplantation.
Whitehead BF. Whitehead BF. Pediatr Pulmonol Suppl. 1997;16:103-4. doi: 10.1002/ppul.1950230858. Pediatr Pulmonol Suppl. 1997. PMID: 9443226 Review.
Cited by
- The Lung Microbiome Predicts Mortality and Response to Azithromycin in Lung Transplant Recipients with Chronic Rejection.
Combs MP, Luth JE, Falkowski NR, Wheeler DS, Walker NM, Erb-Downward JR, Wakeam E, Sjoding MW, Dunlap DG, Admon AJ, Dickson RP, Lama VN. Combs MP, et al. Am J Respir Crit Care Med. 2024 Jun 1;209(11):1360-1375. doi: 10.1164/rccm.202308-1326OC. Am J Respir Crit Care Med. 2024. PMID: 38271553 - Inflammation on bronchoalveolar lavage cytology is associated with decreased chronic lung allograft dysfunction-free survival.
Greenland NY, Deiter F, Calabrese DR, Hays SR, Kukreja J, Leard LE, Kolaitis NA, Golden JA, Singer JP, Greenland JR. Greenland NY, et al. Clin Transplant. 2022 Jun;36(6):e14639. doi: 10.1111/ctr.14639. Epub 2022 Mar 12. Clin Transplant. 2022. PMID: 35246990 Free PMC article. - Elevated peptides in lung lavage fluid associated with bronchiolitis obliterans syndrome.
Stone MD, Harvey SB, Nelsestuen GL, Reilly C, Hertz MI, Wendt CH. Stone MD, et al. PLoS One. 2014 Jan 2;9(1):e84471. doi: 10.1371/journal.pone.0084471. eCollection 2014. PLoS One. 2014. PMID: 24392140 Free PMC article. - Activation of Tissue Remodeling Precedes Obliterative Bronchiolitis in Lung Transplant Recipients.
Ramirez AM, Nunley DR, Rojas M, Roman J. Ramirez AM, et al. Biomark Insights. 2008 Jun 6;3:351-359. doi: 10.4137/bmi.s686. Biomark Insights. 2008. PMID: 19578518 Free PMC article. - C4d deposition and cellular infiltrates as markers of acute rejection in rat models of orthotopic lung transplantation.
Murata K, Iwata T, Nakashima S, Fox-Talbot K, Qian Z, Wilkes DS, Baldwin WM. Murata K, et al. Transplantation. 2008 Jul 15;86(1):123-9. doi: 10.1097/TP.0b013e31817b0b57. Transplantation. 2008. PMID: 18622289 Free PMC article.
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials
Miscellaneous