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Is lymphocytic bronchiolitis a marker of acute rejection? An analysis of 2,697 transbronchial biopsies after lung transplantation.
J Heart Lung Transplant. 2008 Oct; 27(10):1128-34.JH

Abstract

BACKGROUND

Guidelines for the diagnosis and grading of lymphocytic bronchiolitis (LB) have been available for more than a decade, but agreement is lacking concerning the clinical implications of this histologic finding.

OBJECTIVES

Study goals were to describe the overall prevalence and incidence of LB in a consecutive cohort of lung transplant recipients and identify risk factors for the onset, frequency, and severity of LB.

METHODS

A retrospective analysis was done of 2,697 transbronchial biopsy (TBB) specimens obtained during the first 2 years after transplantation from 299 consecutive patients who underwent transplantation between 1996 and 2006.

RESULTS

Full diameter membranous bronchioli were missing in approximately 30% of TBB specimens. The proportion of patients demonstrating LB remained constant during follow-up (trend test, p = 0.2). The cumulative incidence of LB (>or=B2) was 33%, 53%, 62%, and 68% at 1-, 3-, 6-, and 12-months, respectively. Approximately one-quarter and one-half of the patients had a second episode of >or=B2 within 3 months and 2-years of transplantation, respectively. Exposure to LB during the first 2 years after transplantation was independently associated with the frequency and/or severity of acute cellular rejection (p < 0.0001). The choice between anti-thymocyte globulin or daclizumab induction did not alter the overall frequency and/or severity of LB (p = 0.7). LB grade B2 or higher was associated with increased histologic bronchiolitis obliterans (odds ratio, 3.3, 95% confidence interval, 1.5-6.9, p = 0.001).

CONCLUSIONS

The frequency and severity of LB was associated with the occurrence and severity of acute cellular rejection.

Authors+Show Affiliations

Department of Cardiology, Division of Lung Transplantation, Institute of Public Health, Copenhagen University, Copenhagen, Denmark. cmburton@doctors.net.ukNo affiliation info availableNo 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

18926405

Citation

Burton, Christopher M., et al. "Is Lymphocytic Bronchiolitis a Marker of Acute Rejection? an Analysis of 2,697 Transbronchial Biopsies After Lung Transplantation." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 27, no. 10, 2008, pp. 1128-34.
Burton CM, Iversen M, Scheike T, et al. Is lymphocytic bronchiolitis a marker of acute rejection? An analysis of 2,697 transbronchial biopsies after lung transplantation. J Heart Lung Transplant. 2008;27(10):1128-34.
Burton, C. M., Iversen, M., Scheike, T., Carlsen, J., & Andersen, C. B. (2008). Is lymphocytic bronchiolitis a marker of acute rejection? An analysis of 2,697 transbronchial biopsies after lung transplantation. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 27(10), 1128-34. https://doi.org/10.1016/j.healun.2008.06.014
Burton CM, et al. Is Lymphocytic Bronchiolitis a Marker of Acute Rejection? an Analysis of 2,697 Transbronchial Biopsies After Lung Transplantation. J Heart Lung Transplant. 2008;27(10):1128-34. PubMed PMID: 18926405.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is lymphocytic bronchiolitis a marker of acute rejection? An analysis of 2,697 transbronchial biopsies after lung transplantation. AU - Burton,Christopher M, AU - Iversen,Martin, AU - Scheike,Thomas, AU - Carlsen,Jørn, AU - Andersen,Claus B, PY - 2007/09/30/received PY - 2008/04/15/revised PY - 2008/06/17/accepted PY - 2008/10/18/pubmed PY - 2009/2/14/medline PY - 2008/10/18/entrez SP - 1128 EP - 34 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 27 IS - 10 N2 - BACKGROUND: Guidelines for the diagnosis and grading of lymphocytic bronchiolitis (LB) have been available for more than a decade, but agreement is lacking concerning the clinical implications of this histologic finding. OBJECTIVES: Study goals were to describe the overall prevalence and incidence of LB in a consecutive cohort of lung transplant recipients and identify risk factors for the onset, frequency, and severity of LB. METHODS: A retrospective analysis was done of 2,697 transbronchial biopsy (TBB) specimens obtained during the first 2 years after transplantation from 299 consecutive patients who underwent transplantation between 1996 and 2006. RESULTS: Full diameter membranous bronchioli were missing in approximately 30% of TBB specimens. The proportion of patients demonstrating LB remained constant during follow-up (trend test, p = 0.2). The cumulative incidence of LB (>or=B2) was 33%, 53%, 62%, and 68% at 1-, 3-, 6-, and 12-months, respectively. Approximately one-quarter and one-half of the patients had a second episode of >or=B2 within 3 months and 2-years of transplantation, respectively. Exposure to LB during the first 2 years after transplantation was independently associated with the frequency and/or severity of acute cellular rejection (p < 0.0001). The choice between anti-thymocyte globulin or daclizumab induction did not alter the overall frequency and/or severity of LB (p = 0.7). LB grade B2 or higher was associated with increased histologic bronchiolitis obliterans (odds ratio, 3.3, 95% confidence interval, 1.5-6.9, p = 0.001). CONCLUSIONS: The frequency and severity of LB was associated with the occurrence and severity of acute cellular rejection. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/18926405/Is_lymphocytic_bronchiolitis_a_marker_of_acute_rejection_An_analysis_of_2697_transbronchial_biopsies_after_lung_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(08)00495-6 DB - PRIME DP - Unbound Medicine ER -