title: Immediate postoperative inflammatory response predicts long-term outcome in lung-transplant recipients.
abstract: OBJECTIVE
  Although lung transplantation is an accepted therapy for end-stage disease, recipient outcomes continue to be hindered by early primary graft dysfunction (PGD) as well as late rejection and bronchiolitis obliterans syndrome (BOS). We have previously shown that the pro-inflammatory cytokine response following transplantation correlates with the severity of PGD. We hypothesized that lung-transplant recipients with an increased inflammatory response immediately following surgery would also have a greater incidence of unfavorable long-term outcomes including rejection, BOS and ultimately death.
  
  
  METHODS
  A retrospective study of lung-transplant recipients (n = 19) for whom serial blood sampling of cytokines was performed for 24 h following transplantation between March 2002 and June 2003 at a single institution. Long-term follow-up was examined for rejection, BOS and survival.
  
  
  RESULTS
  Thirteen single and six bilateral lung recipients were examined. Eleven (58%) developed BOS and eight (42%) did not. Subgroup analysis revealed an association between elevated IL-6 concentrations 4 h after reperfusion of the allograft and development of BOS (P = 0.068). The correlation between IL-6 and survival time was found to be significant (corr = -0.46, P = 0.047), indicating that higher IL-6 response had shorter survival following transplantation.
  
  
  CONCLUSIONS
  An elevation in interleukin (IL)-6 concentration immediately following lung transplantation is associated with a trend towards development of bronchiolitis obliterans, rejection and significantly decreased survival time. Further studies are warranted to confirm the correlation between the immediate inflammatory response, PGD and BOS. Identification of patients at risk for BOS based on the cytokine response after surgery may allow for early intervention.
authors: College of Medicine, University of Florida, Gainesville, FL 32610-0286, USA.
authors: David J
authors: DJ
authors: Hall
authors: Maher
authors: M
authors: Baz
authors: Michael J
authors: MJ
authors: Daniels
authors: Edward Denmark
authors: ED
authors: Staples
authors: Charles T
authors: CT
authors: Klodell
authors: Lyle L
authors: LL
authors: Moldawer
authors: Thomas M
authors: TM
authors: Beaver
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001989:Bronchiolitis Obliterans / Q000097:blood / Q000209:etiology* / Q000401:mortality; D016207:Cytokines / Q000097:blood*; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D015850:Interleukin-6 / Q000097:blood; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D016207:Cytokines; C508600:IL6 protein, human; D015850:Interleukin-6