Bronchoalveolar lavage fluid characteristics in acute and chronic lung transplant rejection.
BACKGROUND
The detection of graft rejection by bronchoalveolar lavage remains controversial.


METHODS
To assess the value of bronchoalveolar lavage fluid in acute and chronic rejection after lung transplantation we analyzed bronchoalveolar lavage fluid cellular differential characteristics, lymphocyte sub-types and interleukin-6 (IL-6) and interleukin-8 (IL-8) cytokine levels in patients with exclusively either acute rejection (n = 37) or bronchiolitis obliterans (BO; n = 48). Both groups were compared with a control group of lung transplantation patients without rejection or infection, matched for the time the lavage was performed after lung transplantation.


RESULTS
The bronchiolitis obliterans group showed marked neutrophilia, high IL-8 and higher CD4(+)CD25(+) and CD8(+)CD45(+) bronchoalveolar lavage fluid levels when compared with their stable controls. When using a cut-off point of >3% neutrophils in the lavage, the sensitivity for BO is 87.0%, the specificity 77.6%. The sensitivity of IL-8 for BO when using a cut-off point of >71.4 pg/ml is 74.5%, the specificity 83.3%. Bronchoalveolar lavage fluid in acute rejection was characterized by marked lymphocytosis, but showed no difference when compared with stable controls in any of the lymphocyte sub-types studied. When using a cut-off point of <==1% lymphocytes in the lavage, the sensitivity for acute rejection (AR) is 40.4%, the specificity 95.6%. The marked neutrophilia, high IL-8 cytokine level and more activated lymphocyte population in bronchiolitis obliterans may indicate ongoing local allograft rejection.


CONCLUSIONS
In the present study we were not able to show any difference in lymphocyte sub-types when comparing acute rejection and control subjects. Cellular and soluble parameters in bronchoalveolar lavage fluid appear useful for diagnosing bronchiolitis obliterans.
Slebos
Dirk-Jan
DJ
Department of Pulmonary Diseases and Lung Transplantation, University Hospital Groningen, Groningen, The Netherlands. dslebos@int.azg.nl
Postma
Dirkje S
DS
Koëter
Gerard H
GH
Van Der Bij
Wim
W
Boezen
Marike
M
Kauffman
Henk F
HF
D000208:Acute Disease; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000209:etiology; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D002452:Cell Count; D002908:Chronic Disease; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000473:pathology; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D016040:Lung Transplantation; D016131:Lymphocyte Subsets / Q000473:pathology; D008297:Male; D012680:Sensitivity and Specificity
D015850:Interleukin-6; D016209:Interleukin-8