Aspiration, Localized Pulmonary Inflammation, and Predictors of Early-Onset Bronchiolitis Obliterans Syndrome after Lung Transplantation Journal Article


Authors: Fisichella, P. M.; Davis, C. S.; Lowery, E.; Ramirez, L; Gamelli, R. L.; Kovacs, E. J.
Article Title: Aspiration, Localized Pulmonary Inflammation, and Predictors of Early-Onset Bronchiolitis Obliterans Syndrome after Lung Transplantation
Abstract: BACKGROUND: We hypothesized that immune mediator concentrations in the bronchoalveolar fluid (BALF) are predictive of bronchiolitis obliterans syndrome (BOS) and demonstrate specific patterns of dysregulation, depending on the presence of acute cellular rejection, BOS, aspiration, and timing of lung transplantation. STUDY DESIGN: We prospectively collected 257 BALF samples from 105 lung transplant recipients. The BALF samples were assessed for absolute and differential white blood cell counts and 34 proteins implicated in pulmonary immunity, inflammation, fibrosis, and aspiration. RESULTS: There were elevated BALF concentrations of interleukin (IL)-15, IL-17, basic fibroblast growth factor, tumor necrosis factor-alpha, and myeloperoxidase, and reduced concentrations of alpha1-antitrypsin, which were predictive of early-onset BOS. Patients with BOS had an increased percentage of BALF lymphocytes and neutrophils, with a reduced percentage of macrophages (p 0.05). The BALF concentrations of IL-1beta; IL-8; interferon-gamma-induced protein 10; regulated upon activation, normal T-cell expressed and secreted; neutrophil elastase; and pepsin were higher in patients with BOS (p 0.05). Among those with BOS, BALF concentrations of IL-1RA; IL-8; eotaxin; interferon-gamma-induced protein 10; regulated upon activation, normal T-cell expressed and secreted; myeloperoxidase; and neutrophil elastase were positively correlated with time since transplantation (p 0.01). Those with worse grades of acute cellular rejection had an increased percentage of lymphocytes in their BALF (p 0.0001) and reduced BALF concentrations of IL-1beta, IL-7, IL-9, IL-12, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interferon-gamma, and vascular endothelial growth factor (p
Keywords: Burn and Shock Trauma Institute
Journal Title: Journal of the American College of Surgeons
Volume: 217
Issue: 1
ISSN: 1879-1190; 1072-7515
Publisher: Elsevier Inc  
Date Published: 2013
Start Page: 90
End Page: 100