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Is Lymphocytic Bronchiolitis a Marker of Acute Rejection? An Analysis of 2,697 Transbronchial Biopsies After Lung Transplantation

Journal
The Journal of Heart and Lung Transplantation
Publisher
Elsevier
Publication Date
Jan 01, 2008
Volume
27
Issue
10
Identifiers
DOI: 10.1016/j.healun.2008.06.014
Disciplines
  • Biology
  • Medicine
License
Unknown

Abstract

Background Guidelines for the diagnosis and grading of lymphocytic bronchiolitis (LB) have been available for more than a decade, but agreement is lacking concerning the clinical implications of this histologic finding. Objectives Study goals were to describe the overall prevalence and incidence of LB in a consecutive cohort of lung transplant recipients and identify risk factors for the onset, frequency, and severity of LB. Methods A retrospective analysis was done of 2,697 transbronchial biopsy (TBB) specimens obtained during the first 2 years after transplantation from 299 consecutive patients who underwent transplantation between 1996 and 2006. Results Full diameter membranous bronchioli were missing in approximately 30% of TBB specimens. The proportion of patients demonstrating LB remained constant during follow-up (trend test, p = 0.2). The cumulative incidence of LB (≥B2) was 33%, 53%, 62%, and 68% at 1-, 3-, 6-, and 12-months, respectively. Approximately one-quarter and one-half of the patients had a second episode of ≥B2 within 3 months and 2-years of transplantation, respectively. Exposure to LB during the first 2 years after transplantation was independently associated with the frequency and/or severity of acute cellular rejection ( p < 0.0001). The choice between anti-thymocyte globulin or daclizumab induction did not alter the overall frequency and/or severity of LB ( p = 0.7). LB grade B2 or higher was associated with increased histologic bronchiolitis obliterans (odds ratio, 3.3, 95% confidence interval, 1.5–6.9, p = 0.001). Conclusions The frequency and severity of LB was associated with the occurrence and severity of acute cellular rejection.

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