Study objectives: To evaluate whether findings from
surveillance bronchoscopy predict survival following lung
Design: Retrospective review and
analysis of 498 bronchoscopies with transbronchial biopsy (TBB) and BAL
performed in 34 patients after lung transplantation.
Setting: University-based, tertiary referral medical
Patients: Thirty-four patients after lung
transplantation. The mean age at transplantation was 49 ± 9 years;
20 (59%) were female. Twenty-four (71%) underwent single and 10
(29%) underwent bilateral lung transplantation. The most common
pretransplantation diagnostic groups were emphysema/COPD without
concomitant α1-antiprotease deficiency (n = 13) and
other obstructive disease processes (n = 10).
Interventions: Over follow-up, subjects underwent multiple
bronchoscopies with TBB and BAL. The median number per subject was 15
(25 to 75% range 13 to 17).
Measurements and results:
We calculated the overall median BAL WBCs and median percent
neutrophils (polymorphonuclear leukocytes [PMNs]) among all of the
BALs performed for each subject. We then calculated the mean ± SD of
those median values. We used Cox proportionate hazards to assess
mortality risk. The median overall follow-up observation period for the
cohort was 560 days. There were 11 deaths during this period.
Twenty-four subjects (71%) had acute rejection (AR) grades 2 to 4
(mild to severe), and nine (27%) had obliterative bronchiolitis (OB)
diagnosed by TBB at any point. The mean value for BAL WBCs was
366 ± 145 × 103 per milliliter; for percentage PMNs,
the mean was 7 ± 10%. Adjusting for age, gender, single vs
bilateral lung transplantation, pretransplantation diagnostic group,
presence of AR, presence of OB, BAL WBC concentration, and lymphocyte
CD4/CD8 ratio, PMN percent was a significant predictor of mortality
(p = 0.02).
Conclusions: Ongoing inflammation
manifested by an increased percentage PMNs over repeated bronchoscopies
predicts mortality following lung transplantation. Biopsy data alone
may be insufficient to identify posttransplantation patients at risk of
Abbreviations: AR = acute rejection;
BOS = bronchiolitis obliterans syndrome; CMV = cytomegalovirus;
OB = obliterative bronchiolitis; PFT = pulmonary function test;
PMNs = neutrophils (polymorphonuclear leukocytes);
TBB = transbronchial biopsy; UCSF = University of California, San