title: Interstitial pneumonitis and the risk of chronic allograft rejection in lung transplant recipients.
abstract: BACKGROUND
  The presence of interstitial pneumonitis (IP) on surveillance lung biopsy specimens in lung transplant recipients is poorly described, and its impact on posttransplant outcomes is not established. The following study assessed the association of posttransplant IP with the development of bronchiolitis obliterans syndrome (BOS).
  
  
  METHODS
  We examined all recipients of primary cadaveric lung transplants at our institution between January 1, 2000, and December 31, 2007 (N = 145). Patients had bronchoscopies with BAL, and transbronchial biopsies performed for surveillance during posttransplant months 1, 3, 6, and 12 as well as when clinically indicated. Patients were given a diagnosis of IP if, in the absence of active infection and organizing pneumonia, they showed evidence of interstitial inflammation and fibrosis on two or more biopsy specimens.
  
  
  RESULTS
  IP was a significant predictor of BOS (OR, 7.84; 95% CI, 2.84-21.67; P &lt; .0001) and was significantly associated with time to development of BOS (hazard ratio, 3.8; 95% CI, 1.93-7.39; P = .0001) within the first 6 years posttransplant. The presence of IP did not correlate with a significantly higher risk of mortality or time to death. There was no association between the presence of IP and the development of or time to acute rejection.
  
  
  CONCLUSIONS
  The presence of IP on lung transplant biopsy specimens suggests an increased risk for BOS, which is independent of the presence of acute cellular rejection.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Boston, MA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Mihalek
authors.affiliation: Department of Medicine; Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Boston, MA; Lovelace Respiratory Research Institute, Albuquerque, NM; Harvard Medical School, Boston, MA.
authors.forename: Ivan O
authors.initials: IO
authors.lastname: Rosas
authors.affiliation: Department of Medicine; Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Padera
authors.affiliation: Department of Medicine; Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Fuhlbrigge
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Hunninghake
authors.affiliation: Department of Medicine; Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Boston, MA; Channing Laboratory, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: DeMeo
authors.affiliation: Lung Transplant Program, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Camp
authors.affiliation: Department of Medicine; Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: hjgoldberg@partners.org.
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D016040:Lung Transplantation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014180:Transplantation; D014184:Transplantation, Homologous