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Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation.
Am J Respir Crit Care Med 2008; 177(9):1033-40AJ

Abstract

RATIONALE

Severe and recurrent acute vascular rejection of the pulmonary allograft is an accepted major risk factor for obliterative bronchiolitis.

OBJECTIVES

We assessed the role of lymphocytic bronchiolitis as a risk factor for bronchiolitis obliterans syndrome (BOS) and death after lung transplantation.

METHODS

Retrospective analysis of 341 90-day survivors of lung transplant performed in 1995-2005 who underwent 1,770 transbronchial lung biopsy procedures.

MEASUREMENTS AND MAIN RESULTS

Transbronchial biopsies showed grade B0 (normal) (n = 501), B1 (minimal) (n = 762), B2 (mild) (n = 176), B3 (moderate) (n = 70), B4 (severe) (n = 4) lymphocytic bronchiolitis, and Bx (no bronchiolar tissue) (n = 75). A total of 182 transbronchial biopsies were ungraded (8 inadequate, 142 cytomegalovirus, 32 other diagnoses). Lung transplant recipients were grouped by highest B grade before diagnosis of BOS: B0 (n = 12), B1 (n = 166), B2 (n = 89), and B3-B4 (n = 51). Twenty-three were unclassifiable. Cumulative incidence of BOS and death were dependent on highest B grade (Kaplan-Meier, P < 0.001, log-rank). Multivariable Cox proportional hazards analysis showed significant risks for BOS were highest B grade (relative risk [RR], 1.62; 95% confidence interval [CI], 1.31-2.00) (P < 0.001), longer ischemic time (RR, 1.00; CI, 1.00-1.00) (P < 0.05), and recent year of transplant (RR, 0.93; CI, 0.87-1.00) (P < 0.05), whereas risks for death were BOS as a time-dependent covariable (RR, 19.10; CI, 11.07-32.96) (P < 0.001) and highest B grade (RR, 1.36; CI, 1.07-1.72) (P < 0.05). Acute vascular rejection was not a significant risk factor in either model.

CONCLUSIONS

Severity of lymphocytic bronchiolitis is associated with increased risk of BOS and death after lung transplantation independent of acute vascular rejection.

Authors+Show Affiliations

The Lung Transplant Unit, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia. aglanville@stvincents.com.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18263803

Citation

Glanville, Allan R., et al. "Severity of Lymphocytic Bronchiolitis Predicts Long-term Outcome After Lung Transplantation." American Journal of Respiratory and Critical Care Medicine, vol. 177, no. 9, 2008, pp. 1033-40.
Glanville AR, Aboyoun CL, Havryk A, et al. Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation. Am J Respir Crit Care Med. 2008;177(9):1033-40.
Glanville, A. R., Aboyoun, C. L., Havryk, A., Plit, M., Rainer, S., & Malouf, M. A. (2008). Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation. American Journal of Respiratory and Critical Care Medicine, 177(9), pp. 1033-40. doi:10.1164/rccm.200706-951OC.
Glanville AR, et al. Severity of Lymphocytic Bronchiolitis Predicts Long-term Outcome After Lung Transplantation. Am J Respir Crit Care Med. 2008 May 1;177(9):1033-40. PubMed PMID: 18263803.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation. AU - Glanville,Allan R, AU - Aboyoun,Christina L, AU - Havryk,Adrian, AU - Plit,Marshall, AU - Rainer,Steven, AU - Malouf,Monique A, Y1 - 2008/02/08/ PY - 2008/2/12/pubmed PY - 2008/5/7/medline PY - 2008/2/12/entrez SP - 1033 EP - 40 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 177 IS - 9 N2 - RATIONALE: Severe and recurrent acute vascular rejection of the pulmonary allograft is an accepted major risk factor for obliterative bronchiolitis. OBJECTIVES: We assessed the role of lymphocytic bronchiolitis as a risk factor for bronchiolitis obliterans syndrome (BOS) and death after lung transplantation. METHODS: Retrospective analysis of 341 90-day survivors of lung transplant performed in 1995-2005 who underwent 1,770 transbronchial lung biopsy procedures. MEASUREMENTS AND MAIN RESULTS: Transbronchial biopsies showed grade B0 (normal) (n = 501), B1 (minimal) (n = 762), B2 (mild) (n = 176), B3 (moderate) (n = 70), B4 (severe) (n = 4) lymphocytic bronchiolitis, and Bx (no bronchiolar tissue) (n = 75). A total of 182 transbronchial biopsies were ungraded (8 inadequate, 142 cytomegalovirus, 32 other diagnoses). Lung transplant recipients were grouped by highest B grade before diagnosis of BOS: B0 (n = 12), B1 (n = 166), B2 (n = 89), and B3-B4 (n = 51). Twenty-three were unclassifiable. Cumulative incidence of BOS and death were dependent on highest B grade (Kaplan-Meier, P < 0.001, log-rank). Multivariable Cox proportional hazards analysis showed significant risks for BOS were highest B grade (relative risk [RR], 1.62; 95% confidence interval [CI], 1.31-2.00) (P < 0.001), longer ischemic time (RR, 1.00; CI, 1.00-1.00) (P < 0.05), and recent year of transplant (RR, 0.93; CI, 0.87-1.00) (P < 0.05), whereas risks for death were BOS as a time-dependent covariable (RR, 19.10; CI, 11.07-32.96) (P < 0.001) and highest B grade (RR, 1.36; CI, 1.07-1.72) (P < 0.05). Acute vascular rejection was not a significant risk factor in either model. CONCLUSIONS: Severity of lymphocytic bronchiolitis is associated with increased risk of BOS and death after lung transplantation independent of acute vascular rejection. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/18263803/Severity_of_lymphocytic_bronchiolitis_predicts_long_term_outcome_after_lung_transplantation_ L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.200706-951OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -