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Inflammatory cells and activation markers in BAL during acute rejection and infection in lung transplant recipients: a prospective, longitudinal study

Artikel i vetenskaplig tidskrift
Författare Gerdt C. Riise
Christer Kjellström
Walter Ryd
Henrik Scherstén
Folke Nilsson
Gunnar Mårtensson
Bengt A. Andersson
Publicerad i Eur Respir J
Volym 10
Nummer/häfte 8
Sidor 1742-6
ISSN 0903-1936 (Print)
Publiceringsår 1997
Publicerad vid Institutionen för laboratoriemedicin
Hjärt-kärlinstitutionen
Institutionen för medicinsk mikrobiologi och immunologi
Institutionen för invärtesmedicin
Sidor 1742-6
Språk en
Länkar www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Acute Disease, Adult, Biological Markers, Bronchoalveolar Lavage Fluid/*chemistry/*cytology, Female, Graft Rejection/metabolism/*pathology, Heart-Lung Transplantation, Humans, Infection/metabolism/*pathology, Longitudinal Studies, Lung Diseases/metabolism/*pathology, *Lung Transplantation, Male, Middle Aged, Pneumonia/metabolism/pathology, Postoperative Complications, Prospective Studies
Ämneskategorier Dermatologi och venereologi

Sammanfattning

Acute rejection of the transplanted lung is a clinical problem, since it decreases graft survival and predisposes the patient to chronic rejection and obliterative bronchiolitis (OB). In an earlier study, we had indications that eosinophil cationic protein (ECP) from activated eosinophils and hyaluronan (HYA) from fibroblasts were associated with acute pulmonary rejection. This prospective longitudinal study was designed to investigate whether molecules from activated inflammatory cells in bronchoalveolar lavage (BAL) fluid could serve as clinically useful diagnostic markers for acute rejection. BAL fluid from 138 bronchoscopies performed in 10 single lung, four bilateral lung and five heart-lung transplant recipients were analysed. Nine patients were studied for a period of more than 1 yr (mean 13.4 months) after surgery. Differential cell counts were made from the BAL fluid. ECP, myeloperoxidase (MPO), HYA and interleukin-8 (IL-8) were used as indirect markers for activation and attraction of eosinophils, neutrophils and fibroblasts, respectively. Fifty four episodes of acute rejection were diagnosed. Two patients developed OB. Nine episodes of bacterial infection, 13 episodes of cytomegalovirus (CMV) pneumonitis, three of Pneumocystis carinii infection and one of respiratory syncytial virus (RSV) infection were diagnosed. The mean levels of ECP, MPO, HYA and IL-8 were all higher during rejection episodes, but differences were not statistically significant compared to no rejection, when the confounding factors of time, concomitant infection, and repeated measures in the same individual had been accounted for. We could not confirm that measurements of eosinophil cationic protein, myeloperoxidase, hyaluronan and interleukin-8 in bronchoalveolar lavage fluid can be used as diagnostic markers for acute rejection in the postoperative follow-up of lung transplant recipients.

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