Prognostic value of bronchoalveolar lavage neutrophilia in stable lung transplant recipients.
BACKGROUND
Bronchoalveolar lavage (BAL) neutrophilia may identify patients prone to develop bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). This study assessed the predictive value of BAL neutrophilia in stable recipients.


METHODS
Evaluated were 63 consecutive recipients 3 to 12 months after LTx demonstrating no acute rejection (AR) and lymphocytic bronchitis (LB; B < or = 1 without infection; BOS, 0). Recipients were subdivided into never-BOS (follow-up > or = 12 months) and ever-BOS groups (i.e., BOS development > or = 1 after bronchoscopy).


RESULTS
The groups were statistically indistinguishable for demographic data and preceding AR and LB episodes. Onset of BOS was at a median of 232 days (range, 87-962) after bronchoscopy. The ever-BOS group (16 patients) demonstrated a significantly higher percentage of neutrophils compared with the never-BOS group (47 patients) at the time of bronchoscopy (33.6% +/- 2.1% vs 9.9% +/- 1.1%, p < 0.05). By Cox regression analysis, a BAL neutrophil percentage of > or = 20% remained a significant predictor for BOS > or = 1 (hazard ratio, 3.57; 95% confidence interval, 1.71-8.40, p < 0.05) distinct from known potential BOS predictor variables. The positive and negative predictive value of BAL neutrophilia of > or = 20% for future BOS was 0.72 and 0.93, respectively (p < 0.05).


CONCLUSIONS
BAL neutrophilia in stable recipients is of predictive value to identify recipients at risk for BOS. These data warrant prospective confirmation and further studies to evaluate the benefit of preemptive therapy for potential BOS patients.
Department of Internal Medicine I, Division of Pulmonary Diseases, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Claus
C
Neurohr
Patrick
P
Huppmann
Benedikt
B
Samweber
Stefan
S
Leuschner
Gregor
G
Zimmermann
Hanno
H
Leuchte
Rainer
R
Baumgartner
Rudolf
R
Hatz
Ludwig
L
Frey
Peter
P
Ueberfuhr
Iris
I
Bittmann
Juergen
J
Behr
D000328:Adult; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology*; D001999:Bronchoscopy; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D006801:Humans; D016209:Interleukin-8 / Q000378:metabolism; D007958:Leukocyte Count; D016040:Lung Transplantation / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology* / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D053481:Secretory Leukocyte Peptidase Inhibitor / Q000378:metabolism
D016209:Interleukin-8; C506814:SLPI protein, human; D053481:Secretory Leukocyte Peptidase Inhibitor