title: Role of cytokine profile in the differential diagnosis between acute lung rejection and pulmonary infections after lung transplantation†.
abstract: OBJECTIVE
  Acute lung rejection (ALR) is a relatively frequent complication during the first year after lung transplantation (LT). It is characterized by perivascular/bronchial mononuclear inflammation mediated by several cytokines. The aim of our study was to monitor a panel of cytokines extracted from the bronchoalveolar lavage (BAL) during the first year after LT and correlate them with clinical ALR.
  
  
  METHODS
  Twenty double lung transplant recipients were prospectively assessed. Fifteen (75%) were affected by cystic fibrosis (CF). BAL was collected at seven different steps (pretransplant, immediately post-transplant, after 1 week, 1, 3, 6 months and 1 year). A panel of six cytokines was analysed: tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, macrophage inflammatory protein (MIP)-1α and IL-10. We correlated the cytokine levels with clinical ALR episodes, bacterial and cytomegalovirus (CMV) infections.
  
  
  RESULTS
  One hundred and thirty-eight BAL samples were collected and analysed. In CF patients, the levels of proinflammatory cytokines significantly dropped immediately after the transplant while they increased in all the other patients. Four patients (20%) died between 6 months and 1 year. Nine patients (45%) showed one clinical ALR episode within 6 months; in 6 (30%) patients, a bacterial pneumonia was diagnosed and 5 (25%) developed CMV infection. No differences with the complication rate between CF and non-CF patients were observed. During the infection episodes, all proinflammatory cytokines increased with low levels of IL-10; in case of ALR, levels of IL-1β and MIP-1α increased significantly (P = 0.01 and P < 0.0001), IL-10 levels were higher compared with the infection episodes (P = 0.03). No significant changes were observed for TNF-α, IL-6 and IL-8.
  
  
  CONCLUSIONS
  The BAL cytokine profile (IL-1β, MIP-1α and IL-10) seems useful to differentiate ALR and infections.
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy miripat_6@yahoo.it.
authors.forename: Miriam
authors.initials: M
authors.lastname: Patella
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Anile
authors.affiliation: Department of Biology and Biotechnology 'Charles Darwin', University of Rome Sapienza, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Del Porto
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Diso
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy.
authors.forename: Ylenia
authors.initials: Y
authors.lastname: Pecoraro
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Onorati
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Mantovani
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: De Giacomo
authors.affiliation: Department of Biology and Biotechnology 'Charles Darwin', University of Rome Sapienza, Rome, Italy.
authors.forename: Fiorentina
authors.initials: F
authors.lastname: Ascenzioni
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy.
authors.forename: Erino A
authors.initials: EA
authors.lastname: Rendina
authors.affiliation: Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
mesh_terms: D000208:Acute Disease; D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000276:immunology; D016207:Cytokines / Q000032:analysis*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000276:immunology
chemical_list: D016207:Cytokines
keywords: Acute lung rejection; Bronchiolitis obliterans; Bronchoalveolar lavage; Cytokines; Lung transplantation