Lung rejectionAirway Vascular Changes After Lung Transplant: Potential Contribution to the Pathophysiology of Bronchiolitis Obliterans Syndrome
Section snippets
Study Population
Twenty-seven initially stable LT recipients (LTR), all BOS 01 3 to 9 months after LTx, were recruited at The Alfred Hospital between January 1997 and December 1998 (Table 1). They were followed for at least 3 years with surveillance bronchoscopic analyses that included sampling of bronchoalveolar lavage (BAL), endobronchial biopsy (EBB), and transbronchial biopsy (TBB). Nine healthy, asymptomatic, non-smoking volunteers (6 men, mean age of 31.8 years) with normal lung function were recruited as
Clinical Outcomes
Patient demographics and baseline clinical characteristics are listed in Table 1. In the Stable Group, 31 bronchoscopies were performed on 8 recipients. Eleven microorganisms were detected (6 bacterial, 4 viral, and 1 fungal), and 3 clinical infections were diagnosed from these procedures. Grade A2 rejection was diagnosed on 1 occasion.19 In the Ever BOS Group, 54 bronchoscopies were performed on 19 recipients, 17 after BOS developed (detected at a mean of 488 ± 290 days after LTx). Twenty-nine
Discussion
This study has demonstrated the presence and persistence of early increased airway vascularity in human lung allografts. This is potentially related to peri-operative events (most likely ischemia) and is probably further contributed to by subsequent airway allograft inflammation. Interestingly, increases in airway vasculature are not associated with the time after transplant or the presence of infection as indicated by both univariate and multivariable analyses.
In human lung transplantation,
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