A novel approach to the assessment of lymphocytic bronchiolitis after lung transplantation—transbronchial brush
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- 作者：Daniel C. Chambers MB ; BS ; MDa ; daniel_chambers@health.qld.gov.au ; Sandra Hodge MSc ; PhDb ; Greg Hodge PhDb ; Stephanie T. Yerkovich PhDa ; Fiona D. Kermeen MB ; BS ; FRACPa ; Paul Reynolds MBBS ; PhDb ; Mark Holmes MB ; BS ; MDb ; Peter M.A. Hopkins MB ; BS ; FRACPa
- 关键词：lung transplant ; T cells ; CD103 ; intraepithelial ; rejection ; infection ; small airway
- 刊名：The Journal of Heart and Lung Transplantation
- 出版年：2011
- 出版时间：May 2011
- 年：2011
- 卷：30
- 期：5
- 页码：544-551
- 全文大小：701 K
文摘
Background
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.Methods
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).
Results
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).
Conclusion
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.