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Interstitial inflammatory lesions of the pulmonary allograft: a retrospective analysis of 2697 transbronchial biopsies.
Transplantation. 2008 Sep 27; 86(6):811-9.T

Abstract

BACKGROUND

Parenchymal and bronchial inflammatory and fibrotic lesions other than acute cellular rejection (ACR) and lymphocytic bronchiolitis are prevalent; however, the context in which they appear is unknown, and often no specific treatment is instigated.

OBJECTIVES

To describe the prevalence, incidence and possible associations between commonly identified inflammatory and fibrotic lesions in the pulmonary allograft.

METHODS

Retrospective chart review of all transbronchial biopsies performed within the first 2 years of 299 lung-transplanted patients in the period 1996 to 2006.

RESULTS

A total of 2697 biopsies were evaluated corresponding to a mean of 6+/-2 (median 8) completed schedules per patient. Diffuse alveolar damage (DAD) was the second most common histological finding within the first 2 weeks after transplantation. The peak prevalence of bronchiolitis obliterans organizing pneumonia (BOOP) and interstitial pneumonitis occurred at 4 to 6 weeks, and 6 to 12 weeks, respectively. There was a steady increase in the cumulative proportion of patients with fibrosis and bronchiolitis obliterans, at each successive scheduled surveillance time point beyond 3 months posttransplantation. The strongest histological correlations were between ACR and lymphocytic bronchiolitis (OR 5.1, P<0.0001) or interstitial fibrosis (OR 3.2, P<0.0001). Patients with interstitial pneumonitis and pulmonary hemosiderosis were also more likely to demonstrate the finding of interstitial fibrosis (OR 3.0 and 3.7, P<0.0001, respectively). Acute cellular rejection was not associated with DAD, and patients with lymphocytic bronchiolitis were not more likely to demonstrate features of organizing pneumonia (DAD or BOOP).

CONCLUSIONS

Histologic findings of ACR, lymphocytic bronchiolitis, BOOP, and interstitial pneumonitis were directly associated with the development of interstitial fibrosis and bronchiolitis obliterans.

Authors+Show Affiliations

Division of Lung Transplantation, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. cmburton@doctors.net.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18813106

Citation

Burton, Christopher M., et al. "Interstitial Inflammatory Lesions of the Pulmonary Allograft: a Retrospective Analysis of 2697 Transbronchial Biopsies." Transplantation, vol. 86, no. 6, 2008, pp. 811-9.
Burton CM, Iversen M, Carlsen J, et al. Interstitial inflammatory lesions of the pulmonary allograft: a retrospective analysis of 2697 transbronchial biopsies. Transplantation. 2008;86(6):811-9.
Burton, C. M., Iversen, M., Carlsen, J., & Andersen, C. B. (2008). Interstitial inflammatory lesions of the pulmonary allograft: a retrospective analysis of 2697 transbronchial biopsies. Transplantation, 86(6), 811-9. https://doi.org/10.1097/TP.0b013e3181852f02
Burton CM, et al. Interstitial Inflammatory Lesions of the Pulmonary Allograft: a Retrospective Analysis of 2697 Transbronchial Biopsies. Transplantation. 2008 Sep 27;86(6):811-9. PubMed PMID: 18813106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interstitial inflammatory lesions of the pulmonary allograft: a retrospective analysis of 2697 transbronchial biopsies. AU - Burton,Christopher M, AU - Iversen,Martin, AU - Carlsen,Jørn, AU - Andersen,Claus B, PY - 2008/9/25/pubmed PY - 2008/11/18/medline PY - 2008/9/25/entrez SP - 811 EP - 9 JF - Transplantation JO - Transplantation VL - 86 IS - 6 N2 - BACKGROUND: Parenchymal and bronchial inflammatory and fibrotic lesions other than acute cellular rejection (ACR) and lymphocytic bronchiolitis are prevalent; however, the context in which they appear is unknown, and often no specific treatment is instigated. OBJECTIVES: To describe the prevalence, incidence and possible associations between commonly identified inflammatory and fibrotic lesions in the pulmonary allograft. METHODS: Retrospective chart review of all transbronchial biopsies performed within the first 2 years of 299 lung-transplanted patients in the period 1996 to 2006. RESULTS: A total of 2697 biopsies were evaluated corresponding to a mean of 6+/-2 (median 8) completed schedules per patient. Diffuse alveolar damage (DAD) was the second most common histological finding within the first 2 weeks after transplantation. The peak prevalence of bronchiolitis obliterans organizing pneumonia (BOOP) and interstitial pneumonitis occurred at 4 to 6 weeks, and 6 to 12 weeks, respectively. There was a steady increase in the cumulative proportion of patients with fibrosis and bronchiolitis obliterans, at each successive scheduled surveillance time point beyond 3 months posttransplantation. The strongest histological correlations were between ACR and lymphocytic bronchiolitis (OR 5.1, P<0.0001) or interstitial fibrosis (OR 3.2, P<0.0001). Patients with interstitial pneumonitis and pulmonary hemosiderosis were also more likely to demonstrate the finding of interstitial fibrosis (OR 3.0 and 3.7, P<0.0001, respectively). Acute cellular rejection was not associated with DAD, and patients with lymphocytic bronchiolitis were not more likely to demonstrate features of organizing pneumonia (DAD or BOOP). CONCLUSIONS: Histologic findings of ACR, lymphocytic bronchiolitis, BOOP, and interstitial pneumonitis were directly associated with the development of interstitial fibrosis and bronchiolitis obliterans. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/18813106/Interstitial_inflammatory_lesions_of_the_pulmonary_allograft:_a_retrospective_analysis_of_2697_transbronchial_biopsies_ L2 - https://doi.org/10.1097/TP.0b013e3181852f02 DB - PRIME DP - Unbound Medicine ER -