A novel approach to the assessment of lymphocytic bronchiolitis after Lung transplantation-transbronchial brush

作者：Chambers Daniel C^*; Hodge Sandra; Hodge Greg; Yerkovich Stephanie T; Kermeen Fiona D; Reynolds Paul; Holmes Mark; Hopkins Peter M A

来源：Journal of Heart and Lung Transplantation, 2011, 30(5): 544-551.

DOI：10.1016/j.healun.2010.10.018

• lung transplant
• T cells
• CD103
• intraepithelial
• rejection
• infection
• small airway
• flow cytometry
• lymphocytic bronchiolitis

BACKGROUND: Lymphocytic bronchiolitis (LB) is the strongest risk factor for subsequent allograft loss due to bronchiolitis obliterative syndrome (BUS); however, it is poorly assessed by transbronchial biopsy (TBBx) because of sampling error, interpretation error and the presence of non-alloimmune airway inflammation. We hypothesized that flow cytometric evaluation of bronchiolar brushings (transbronchial brush, TBBr) may be a better approach.
METHODS: Transbronchial brushings (2 to 3 cm from the pleural surface under radiologic guidance) were obtained prior to TBBx in 32 patients and analyzed by flow cytometry. We assessed the proportion of nucleated cells that were CD3(+)CD103(+) (epithelial-specific T cells).
RESULTS: No adverse events occurred; 0.5% (0.27 to 0.84) of the cells were epithelial-specific T cells and numbers increased with episodes of Grade A1 rejection (p < 0.01) and in patients with BUS (p = 0.02). Viral and invasive fungal infection were associated with marked infiltration with CD103(-) T cells (p < 0.01).
CONCLUSION: TBBr is simple to obtain, low risk, quantitative, and can discriminate between infective and alloimmune LB. It may be a valuable addition to current lung allograft assessment.

• 出版日期2011-5