title: A novel approach to the assessment of lymphocytic bronchiolitis after lung transplantation--transbronchial brush.
abstract: BACKGROUND
  Lymphocytic bronchiolitis (LB) is the strongest risk factor for subsequent allograft loss due to bronchiolitis obliterative syndrome (BOS); however, it is poorly assessed by transbronchial biopsy (TBBx) because of sampling error, interpretation error and the presence of non-alloimmune airway inflammation. We hypothesized that flow cytometric evaluation of bronchiolar brushings (transbronchial brush, TBBr) may be a better approach.
  
  
  METHODS
  Transbronchial brushings (2 to 3 cm from the pleural surface under radiologic guidance) were obtained prior to TBBx in 32 patients and analyzed by flow cytometry. We assessed the proportion of nucleated cells that were CD3(+)CD103(+) (epithelial-specific T cells).
  
  
  RESULTS
  No adverse events occurred; 0.5% (0.27 to 0.84) of the cells were epithelial-specific T cells and numbers increased with episodes of Grade A1 rejection (p < 0.01) and in patients with BOS (p = 0.02). Viral and invasive fungal infection were associated with marked infiltration with CD103(-) T cells (p < 0.01).
  
  
  CONCLUSIONS
  TBBr is simple to obtain, low risk, quantitative, and can discriminate between infective and alloimmune LB. It may be a valuable addition to current lung allograft assessment.
authors.affiliation: Queensland Centre for Pulmonary Transplantation and Vascular Disease, The Prince Charles Hospital, Brisbane, Queensland, Australia. daniel_chambers@health.qld.gov.au
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Chambers
authors.forename: Sandra
authors.initials: S
authors.lastname: Hodge
authors.forename: Greg
authors.initials: G
authors.lastname: Hodge
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Yerkovich
authors.forename: Fiona D
authors.initials: FD
authors.lastname: Kermeen
authors.forename: Paul
authors.initials: P
authors.lastname: Reynolds
authors.forename: Mark
authors.initials: M
authors.lastname: Holmes
authors.forename: Peter M A
authors.initials: PM
authors.lastname: Hopkins
mesh_terms: D000328:Adult; D015703:Antigens, CD / Q000378:metabolism; D001980:Bronchi / Q000473:pathology*; D001988:Bronchiolitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D001989:Bronchiolitis Obliterans / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D001999:Bronchoscopy / Q000379:methods*; D003430:Cross-Sectional Studies; D003948:Diagnostic Techniques, Respiratory System; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D039001:Integrin alpha Chains / Q000378:metabolism; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology
chemical_list: D015703:Antigens, CD; D039001:Integrin alpha Chains; C091367:alpha E integrins