title: Alveolar neutrophilia is a predictor for the bronchiolitis obliterans syndrome, and increases with degree of severity.
abstract: BACKGROUND
  Bronchiolitis obliterans syndrome (BOS) is a common complication of lung transplantation (LT), associated with a tremendous mortality and morbidity. Recent innovative research has focused on bronchoalveolar lavage (BAL) analysis, assuming that neutrophilia might be a marker of chronic rejection.
  
  
  METHODS
  To address this issue, we retrospectively analyzed 258 sequential BAL from 44 lung transplant recipients, having survived for more than 3 months after surgery.
  
  
  RESULTS
  At the end of the follow-up, 22, 7, 7 and 8 patients had BOS stage 0, 1, 2 and 3, respectively. The total cell count and neutrophilia increased with BOS severity (P < 0.01). BOS occuring before and after the 12th month of LT were associated with early and more delayed increases of BAL neutrophils, respectively. Finally, the various kinetic profiles of neutrophil progression were identified, allowing for an earlier identification of BOS stages 2 and 3, by 3 and 6 months, respectively. Conversely, neutrophilia associated to BOS stage 1 remained low, and could not be distinguished from that of stage 0.
  
  
  CONCLUSIONS
  These results support the possible role of neutrophils in BOS pathogenesis, and may be of interest for an earlier detection and management of chronic rejection.
authors.affiliation: Department of Respiratory Medicine, DMAS, Hôpital A. Michallon, Université J. Fourier, CHU de Grenoble, BP 217, 38043 Grenoble 09, France. GDevouassoux@chu-grenoble.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Devouassoux
authors.forename: Christian
authors.initials: C
authors.lastname: Drouet
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pin
authors.forename: Christian
authors.initials: C
authors.lastname: Brambilla
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brambilla
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Colle
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
mesh_terms: D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000473:pathology; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D002452:Cell Count; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009504:Neutrophils / Q000502:physiology*; D011650:Pulmonary Alveoli / Q000473:pathology*; D012189:Retrospective Studies