Lung rejectionUpregulation of chemokines in bronchoalveolar lavage fluid as a predictive marker of post-transplant airway obliteration☆
Section snippets
Transplant population
Starting in January 1997, we enrolled in a prospective cohort study all patients who underwent a double lung or heart–lung allograft at our institution. Twenty-one consecutive recipients who survived at least 1 year after the transplantation procedure were evaluated up to June 2000. Informed consent was obtained from the patients. The patients’ underlying diseases were cystic fibrosis (n = 9), bronchectasis (n = 2), emphysema (n = 4), primary pulmonary hypertension (n = 1), Eisenmenger syndrome
Results
The median time of follow-up was 627 days (range 428 to 1,460) during which a total of 137 BAL samples (median 6 tests/patient, range 5 to 15) obtained from 21 lung transplant recipients were analyzed. The number of patients and (samples) in each group were as follows: 13 stable healthy recipients free from BOS (n = 70); and 8 recipients suffering from BOS during follow-up (n = 67, including 50 samples obtained during the pre-BOS diagnostic phase, and 17 samples obtained during the post-BOS
Discussion
Post-transplant obliterative bronchiolitis results from a chronic immunologic/inflammatory insult to distal airways that leads to fibroproliferation and obliteration of the luminal space of the allograft. Although the mechanism by which this fibrotic response in OB is believed to be multi-factorial and involves various inflammatory cells, the persistence of recruitment and of activation of neutrophils in the alveolar space has been suggested as one of them.9, 10, 11, 12 Indeed,
Acknowledgements
The authors thank J.F. Dumon, B. Meric, P. Cau and L. Garbe for their excellent technical assistance, and A.L. Flori and N. Morati for providing the data acquisition system.
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Supported by the Assistance Publique, Hôpitaux de Marseille.