title: Bronchoalveolar lavage neutrophilia in acute lung allograft rejection and lymphocytic bronchiolitis.
abstract: BACKGROUND
  Acute cellular rejection and lymphocytic bronchiolitis can impair allograft function after lung transplant (LTx). Both may be refractory to corticosteroid treatment. We hypothesized that bronchoalveolar lavage (BAL) neutrophilia may be increased in either acute rejection or lymphocytic bronchiolitis or may increase with increasing histologic severity.
  
  
  METHODS
  All consecutive BAL with subsequent transbronchial biopsy (TBB) specimens, performed in 339 LTx recipients from 2001 to 2008, were retrospectively analyzed. TBB specimens were classified according to histologic grade with analysis of BAL total cell count and cell differentials.
  
  
  RESULTS
  The analysis included 768 TBB specimens. After adjustment for possible confounders, BAL total cell count significantly increased both with grade A or B severity (p < 0.0001). A higher A grade was characterized by a significant increase in BAL lymphocytosis and neutrophilia (p < 0.0001), whereas for higher B grades, only a more prominent BAL neutrophilia was seen (p < 0.0001).
  
  
  CONCLUSIONS
  Higher grade A, but, particularly, higher grade B severity scores are characterized by increased BAL neutrophilia.
authors.affiliation: Laboratory of Pneumology, Katholieke Universiteit Leuven and University Hospital Gasthuisberg, 49 Herestraat, Leuven, Belgium.
authors.forename: Robin
authors.initials: R
authors.lastname: Vos
authors.forename: Bart M
authors.initials: BM
authors.lastname: Vanaudenaerde
authors.forename: Stijn E
authors.initials: SE
authors.lastname: Verleden
authors.forename: Stéphanie I
authors.initials: SI
authors.lastname: De Vleeschauwer
authors.forename: Anna
authors.initials: A
authors.lastname: Willems-Widyastuti
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.forename: Lieven J
authors.initials: LJ
authors.lastname: Dupont
authors.forename: Tim S
authors.initials: TS
authors.lastname: Nawrot
authors.forename: Erik K
authors.initials: EK
authors.lastname: Verbeken
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
mesh_terms: D000328:Adult; D001988:Bronchiolitis / Q000473:pathology* / Q000503:physiopathology; D018893:Bronchoalveolar Lavage; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D016040:Lung Transplantation / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014184:Transplantation, Homologous