title: Elevated bronchoalveolar lavage eosinophilia correlates with poor outcome after lung transplantation.
abstract: BACKGROUND
  Eosinophils are involved in the pathophysiology of many respiratory diseases, but the exact role of eosinophilia in lung transplantation has not been thoroughly investigated.
  
  
  METHODS
  We performed a retrospective analysis of our transplanted patients between 2001 and 2011, with a minimum follow-up of 1 year. Using a cutoff of ≥2% eosinophilia in bronchoalveolar lavage (BAL) fluid, chronic lung allograft dysfunction (CLAD)-free survival and overall survival was compared between 66 patients demonstrating at least one BAL with eosinophils ≥2% and 253 control patients (never BAL ≥2%).
  
  
  RESULTS
  Patients with increased BAL eosinophilia demonstrated worse CLAD-free and overall survival (both P<0.0001) compared with controls. Eosinophilic BAL predisposed to development of bronchiolitis obliterans syndrome but particularly to restrictive allograft syndrome (P<0.0001). After correction for covariates, the association between eosinophilic BAL and CLAD but equally death remained significant (P=0.0047 and 0.0011). Blood eosinophil and C-reactive protein levels were also elevated at the time of eosinophilic BAL.
  
  
  CONCLUSIONS
  BAL eosinophilia ≥2% is associated with poor outcome in our lung transplant patients as demonstrated by worse CLAD-free and overall survival. Interestingly, increased BAL eosinophilia may be specifically associated with the development of restrictive allograft syndrome, which needs further prospective investigation.
authors.affiliation: 1 Leuven Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, Leuven, Belgium. 2 Address correspondence to: Dr. Stijn E. Verleden, Leuven Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, O&N1, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Stijn E
authors.initials: SE
authors.lastname: Verleden
authors.forename: David
authors.initials: D
authors.lastname: Ruttens
authors.forename: Elly
authors.initials: E
authors.lastname: Vandermeulen
authors.forename: Dirk E
authors.initials: DE
authors.lastname: van Raemdonck
authors.forename: Bart M
authors.initials: BM
authors.lastname: Vanaudenaerde
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.forename: Robin
authors.initials: R
authors.lastname: Vos
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000209:etiology; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004804:Eosinophils / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008168:Lung / Q000473:pathology*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011657:Pulmonary Eosinophilia / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein