title: Significance of a solitary perivascular mononuclear infiltrate in lung allograft recipients with mild acute cellular rejection.
abstract: BACKGROUND
  Although a solitary prominent perivascular mononuclear infiltrate is diagnostic of mild acute rejection (A2) in lung allograft recipients, its significance is still poorly defined. We evaluated the significance of a solitary perivascular mononuclear infiltrate and its correlation with clinical outcome in lung allograft recipients.
  
  
  METHODS
  Thirteen patients had mild acute rejection as diagnosed by the presence of a solitary perivascular mononuclear infiltrate. The patients were divided into 2 groups based on subsequent treatment: treated (Group 1) and non-treated (Group 2) patients. We analyzed the difference between the 2 groups according to clinical presentation, histologic parameters and outcome.
  
  
  RESULTS
  Nine patients were women (69%), 4 were men (31%); 12 were white and 1 was African American. Ages at the time of biopsy ranged from 20 to 68 years, with a mean of 47.2 years and a median of 52 years. Eight had a history of single-lung transplant and 5 had a history of double-lung transplant. The most common reasons for transplantation were emphysema (n = 6) and cystic fibrosis (n = 3). Nine patients (65.4%) showed decreased rejection grade or no evidence of acute rejection (Group 1) after treatment. Four patients who were untreated had persistent multifocal mild or worsening moderate rejection on subsequent biopsy (Group 2).
  
  
  CONCLUSIONS
  Treated and untreated patients with mild rejection based on a solitary perivascular infiltrate have similar clinical presentations and histologic characteristics. Solitary mononuclear infiltrates showed persistence or progression without therapy and therefore need to be treated as, not segregated from, the "usual" forms of mild acute allograft rejection.
authors.affiliation: Department of Pathology and Pulmonary Medicine, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA 15213, USA.
authors.forename: Dong-Won
authors.initials: DW
authors.lastname: Kim
authors.forename: Sanja
authors.initials: S
authors.lastname: Dacic
authors.forename: Aldo
authors.initials: A
authors.lastname: Iacono
authors.forename: Wayne
authors.initials: W
authors.lastname: Grgurich
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Yousem
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003550:Cystic Fibrosis / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000473:pathology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000473:pathology / Q000601:surgery; D012720:Severity of Illness Index; D013223:Statistics as Topic; D014184:Transplantation, Homologous; D016896:Treatment Outcome