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Quantitation of T lymphocytes in posttransplant transbronchial biopsies.
Hum Pathol. 2009 Apr; 40(4):505-15.HP

Abstract

The diagnostic role of immunohistochemical staining for T lymphocytes in grading acute airway rejection has not been fully explored. We examined 136 transbronchial biopsies from 52 lung transplant patients and 9 nontransplant controls. Transplant rejection was based on histologic assessment of perivascular (A) and bronchiolar (B) infiltrates. The clinical indication for the 136 allograft biopsies was routine surveillance (n = 72), decreased pulmonary function, rule out rejection (n = 36), suspect infection (n = 16), rule out obliterative bronchiolitis (n = 6), and persistent postoperative graft failure (n = 6). T lymphocytes were counted in bronchial mucosa per 100 bronchial epithelial cells, and in alveolar walls per square millimeters, after immunohistochemical staining with anti-CD3, CD4, and CD8. In controls, the mean alveolar wall CD3 cell count was 45 per square millimeter (95% confidence intervals, 30-52 per square millimeter) and the mean CD8 count was 15 per square millimeter (2-20 per square millimeter). In surveillance and negative patient biopsies, alveolar wall CD8 counts were significantly greater than controls (P = .03 and .02, respectively). Mean alveolar wall CD3 counts were significantly higher in type A rejection (88.7 +/- 12.9) than controls and negative biopsies (42 +/- 5.3, P < .001), but there was no difference compared to infections (119.7 +/- 22, P > .5). Mucosal CD3 cell counts were significantly higher in type B rejection (16.1 +/- 2.5) than controls and negative biopsies (1.5 +/- 0.4, P < .001), and also higher than infections (3.9 +/- 1.1, P < .001). In 7% of biopsies, T-cell staining identified perivascular circumferential infiltrates that were difficult to identify on routine stains, and in an additional 9% minor changes in grading were made after reviewing T-cell markers. Immunohistochemical staining may help in identifying perivascular infiltrates and demonstrates increased intraepithelial T-cells even in low-grade type B rejection. Type B rejection as assessed quantitatively is more specific than type A rejection in comparison to infection.

Authors+Show Affiliations

Department of Genitourinary Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19121842

Citation

Tavora, Fabio, et al. "Quantitation of T Lymphocytes in Posttransplant Transbronchial Biopsies." Human Pathology, vol. 40, no. 4, 2009, pp. 505-15.
Tavora F, Drachenberg C, Iacono A, et al. Quantitation of T lymphocytes in posttransplant transbronchial biopsies. Hum Pathol. 2009;40(4):505-15.
Tavora, F., Drachenberg, C., Iacono, A., & Burke, A. P. (2009). Quantitation of T lymphocytes in posttransplant transbronchial biopsies. Human Pathology, 40(4), 505-15. https://doi.org/10.1016/j.humpath.2008.09.014
Tavora F, et al. Quantitation of T Lymphocytes in Posttransplant Transbronchial Biopsies. Hum Pathol. 2009;40(4):505-15. PubMed PMID: 19121842.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quantitation of T lymphocytes in posttransplant transbronchial biopsies. AU - Tavora,Fabio, AU - Drachenberg,Cinthia, AU - Iacono,Aldo, AU - Burke,Allen P, Y1 - 2009/01/03/ PY - 2008/03/14/received PY - 2008/08/22/revised PY - 2008/09/24/accepted PY - 2009/1/6/entrez PY - 2009/1/6/pubmed PY - 2009/4/22/medline SP - 505 EP - 15 JF - Human pathology JO - Hum. Pathol. VL - 40 IS - 4 N2 - The diagnostic role of immunohistochemical staining for T lymphocytes in grading acute airway rejection has not been fully explored. We examined 136 transbronchial biopsies from 52 lung transplant patients and 9 nontransplant controls. Transplant rejection was based on histologic assessment of perivascular (A) and bronchiolar (B) infiltrates. The clinical indication for the 136 allograft biopsies was routine surveillance (n = 72), decreased pulmonary function, rule out rejection (n = 36), suspect infection (n = 16), rule out obliterative bronchiolitis (n = 6), and persistent postoperative graft failure (n = 6). T lymphocytes were counted in bronchial mucosa per 100 bronchial epithelial cells, and in alveolar walls per square millimeters, after immunohistochemical staining with anti-CD3, CD4, and CD8. In controls, the mean alveolar wall CD3 cell count was 45 per square millimeter (95% confidence intervals, 30-52 per square millimeter) and the mean CD8 count was 15 per square millimeter (2-20 per square millimeter). In surveillance and negative patient biopsies, alveolar wall CD8 counts were significantly greater than controls (P = .03 and .02, respectively). Mean alveolar wall CD3 counts were significantly higher in type A rejection (88.7 +/- 12.9) than controls and negative biopsies (42 +/- 5.3, P < .001), but there was no difference compared to infections (119.7 +/- 22, P > .5). Mucosal CD3 cell counts were significantly higher in type B rejection (16.1 +/- 2.5) than controls and negative biopsies (1.5 +/- 0.4, P < .001), and also higher than infections (3.9 +/- 1.1, P < .001). In 7% of biopsies, T-cell staining identified perivascular circumferential infiltrates that were difficult to identify on routine stains, and in an additional 9% minor changes in grading were made after reviewing T-cell markers. Immunohistochemical staining may help in identifying perivascular infiltrates and demonstrates increased intraepithelial T-cells even in low-grade type B rejection. Type B rejection as assessed quantitatively is more specific than type A rejection in comparison to infection. SN - 1532-8392 UR - https://www.unboundmedicine.com/medline/citation/19121842/Quantitation_of_T_lymphocytes_in_posttransplant_transbronchial_biopsies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0046-8177(08)00444-9 DB - PRIME DP - Unbound Medicine ER -