title: Association of large-airway lymphocytic bronchitis with bronchiolitis obliterans syndrome.
abstract: BACKGROUND
  Lung transplantation offers great promise for otherwise terminal lung diseases, but the development of bronchiolitis obliterans syndrome (BOS) continues to limit survival. Although acute rejection and lymphocytic bronchiolitis have been identified as risk factors for the development of BOS, it is unclear whether large-airway lymphocytic inflammation conveys the same risk.
  
  
  OBJECTIVE
  We evaluated lymphocytic bronchitis on endobronchial biopsies as a risk factor for BOS and mortality.
  
  
  METHODS
  Endobronchial biopsies were collected and graded during surveillance after lung transplantation. We assessed samples with negative cultures collected in the first 90 days from 298 subjects and compared large-airway lymphocytic bronchitis assessed by a 0-2 "E-score" and with standard A and BR pathology scores for acute rejection and small-airway lymphocytic bronchiolitis, respectively.
  
  
  RESULTS
  We found surprisingly little association between large- and small-airway lymphocytic inflammation scores from a given bronchoscopy. Endobronchial lymphocytic bronchitis was more prevalent in subjects in BOS stage 0p and BOS stages 1-3 at the time of biopsy. Within 90 days after transplantation, increasing maximum E-score was associated with greater risk of BOS (adjusted hazard ratio, 1.76; 95% confidence interval, 1.11-2.78; P = 0.02) and in this analysis 90-day maximum E-scores were the only score type predictive of BOS (P < 0.01).
  
  
  CONCLUSIONS
  These results support a multicenter study to evaluate endoscopic biopsies for the identification of patients at increased risk for BOS. The association of endobronchial lymphocytic inflammation and BOS may have mechanistic implications.
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, CA 94121, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Greenland
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Jones
authors.forename: Steve R
authors.initials: SR
authors.lastname: Hays
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Golden
authors.forename: Anatoly
authors.initials: A
authors.lastname: Urisman
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Jewell
authors.forename: George H
authors.initials: GH
authors.lastname: Caughey
authors.forename: Neil N
authors.initials: NN
authors.lastname: Trivedi
mesh_terms: D001706:Biopsy; D001980:Bronchi / Q000473:pathology*; D001989:Bronchiolitis Obliterans / Q000473:pathology*; D001991:Bronchitis / Q000473:pathology; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000473:pathology; D016040:Lung Transplantation / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013577:Syndrome