Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis

Hopkins, Peter M., Aboyoun, Christina L., Chhajed, Prashant N., Malouf, Monique A., Plit, Marshall L., Rainer, Stephen P. and Glanville, Allan R. (2004) Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis. American Journal of Respiratory and Critical Care Medicine, 170 9: 1022-1026. doi:10.1164/rccm.200302-165oc


Author Hopkins, Peter M.
Aboyoun, Christina L.
Chhajed, Prashant N.
Malouf, Monique A.
Plit, Marshall L.
Rainer, Stephen P.
Glanville, Allan R.
Title Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis
Journal name American Journal of Respiratory and Critical Care Medicine   Check publisher's open access policy
ISSN 1073-449X
1535-4970
Publication date 2004-11-01
Year available 2004
Sub-type Article (original research)
DOI 10.1164/rccm.200302-165oc
Open Access Status DOI
Volume 170
Issue 9
Start page 1022
End page 1026
Total pages 5
Place of publication New York, NY, United States
Publisher American Thoracic Society
Language eng
Abstract The clinical significance of minimal acute rejection (grade A,) in lung transplant recipients is unknown. We prospectively analyzed 1,159 transbronchial lung biopsies in 184 patients. Two hundred seventy-nine biopsies in 128 participants confirmed A, histology at a mean postoperative day of 229 +/- 340. Sixty four of 255 surveillance A, lesions progressed to high-grade acute rejection by 3 months of follow-up, whereas 40 developed new lymphocytic bronchiolitis. Twenty-four A, biopsies were symptomatic, with only two cases progressing to high-grade rejection after steroid therapy. Seventy-eight of 184 patients experienced multiple (greater than or equal to 2) A, biopsies in the first 12 months after transplant. Bronchiolitis obliterans syndrome developed in 68% of patients with multiple A(1) lesions at a mean of 599 +/- 435 days, compared with 43% of patients with one or less A, lesions at a mean of 819 +/- 526 (p = 0.022). Eighteen patients experienced multiple A, biopsies after transplant in the absence of high-grade rejection episodes yet also developed earlier obliterative bronchiolitis (456 +/- 245 days, p = 0.020). We conclude that for A(1) transbronchial lung biopsies, the conventional treatment of observation only is now challenged even in patients who are asymptomatic. Patients who experience multiple A(1) lesions develop an earlier onset of obliterative bronchiolitis and may warrant alternative immunosuppressive strategies.
Formatted abstract
The clinical significance of minimal acute rejection (grade A1) in lung transplant recipients is unknown. We prospectively analyzed 1,159 transbronchial lung biopsies in 184 patients. Two hundred seventy-nine biopsies in 128 participants confirmed A1 histology at a mean postoperative day of 229 ± 340. Sixty four of 255 surveillance A1 lesions progressed to high-grade acute rejection by 3 months of follow-up, whereas 40 developed new lymphocytic bronchiolitis. Twenty-four A1 biopsies were symptomatic, with only two cases progressing to high-grade rejection after steroid therapy. Seventy-eight of 184 patients experienced multiple (≥2) A1 biopsies in the first 12 months after transplant. Bronchiolitis obliterans syndrome developed in 68% of patients with multiple A1 lesions at a mean of 599 ± 435 days, compared with 43% of patients with one or less A1 lesions at a mean of 819 ± 526 (p = 0.022). Eighteen patients experienced multiple A1 biopsies after transplant in the absence of high-grade rejection episodes yet also developed earlier obliterative bronchiolitis (456 ± 245 days, p = 0.020). We conclude that for A1 transbronchial lung biopsies, the conventional treatment of observation only is now challenged even in patients who are asymptomatic. Patients who experience multiple A1 lesions develop an earlier onset of obliterative bronchiolitis and may warrant alternative immunosuppressive strategies.
Keyword Lung transplant
Minimal rejection
Obliterative bronchiolitis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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