Bronchoalveolar lavage cell immunophenotyping facilitates diagnosis of lung allograft rejection
Greenland JR, Jewell NP, et al.American Journal of Transplantation 2014; 14(4): 831-840
Aims
To investigate whether a large cohort of lung transplant recipients with a combination of immunophenotypes could provide a scoring system to identify acute rejection, predict future acute rejection and discriminate infection from acute rejection.
Interventions
Patients were randomised to a derivation cohort or validation cohort.
Participants
317 lung transplant recipients.
Outcomes
The outcomes included acute cellular rejection which was assessed and graded using standard nomenclature by thoracic pathologists and infection if the analysis of bronchoalveolar lavage fluid included viruses, bacteria, fungi or mycobacteria.
Follow-up
45 days.
CET Conclusions
This is a particularly interesting report in lung transplant patients where the authors have used the immunophenotype of cells in bronchoalveolar lavage samples firstly in a derivation cohort and then in a validation cohort to differentiate between infection and rejection. They have shown that the prevalence of NK cells was increased in the infection group but decreased in the rejection group as well as in the combined infection and rejection group. However CD25+ cells were increased in rejection and decreased in infection. They have used this to develop a clinical scoring system to identify acute rejection in lung transplant recipients as well as to identify patients at risk of future rejection and BOS. These findings need to be assessed in prospective multicentre studies, as the authors suggest, but well worthy of follow up studies.
Quality notes
This is a training and validation study, quality assessment is not appropriate.
Trial registration
Not reported.