Original Research: Transplantation |

Interstitial Pneumonitis and the Risk of Chronic Allograft Rejection in Lung Transplant RecipientsInterstitial Pneumonitis and Lung Transplant

Andrew D. Mihalek, MD; Ivan O. Rosas, MD; Robert F. Padera, Jr, MD, PhD; Anne L. Fuhlbrigge, MD; Gary M. Hunninghake, MD; Dawn L. DeMeo, MD, MPH; Phillip C. Camp, Jr, MD; Hilary J. Goldberg, MD, MPH
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Mihalek and Hunninghake), Department of Medicine; Lung Transplant Program (Drs Rosas, Fuhlbrigge, DeMeo, and Goldberg), Division of Pulmonary and Critical Care Medicine, Department of Medicine; Department of Pathology (Dr Padera); Channing Laboratory (Dr DeMeo); and Lung Transplant Program (Dr Camp), Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA; Lovelace Respiratory Research Institute (Dr Rosas), Albuquerque, NM; and Harvard Medical School (Drs Rosas, Padera, Fuhlbrigge, Hunninghake, DeMeo, Camp, and Goldberg), Boston, MA.

Correspondence to: Hilary J. Goldberg, MD, MPH, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, 75 Francis St, PBB Clinics-3, Boston, MA 02115; e-mail: hjgoldberg@partners.org

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This study did not receive financial support from outside sources. Dr Rosas is supported by the National Institutes of Health [K23 HL087030]. Dr Fuhlbrigge is supported by the National Institutes of Health [5 U01 HL075419, N01 HR76183, 5 R01 HL094635, and 1 R01 HS019408]. Dr Hunninghake is supported by the National Institutes of Health [K08 HL092222]. Dr DeMeo is supported by a Clinical Scientist Development Award from the Doris Duke Charitable Foundation. This work was performed at Brigham and Women’s Hospital, Lung Transplant Program, Boston, MA.

Chest. 2013;143(5):1430-1435. doi:10.1378/chest.12-0354
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Background:  The presence of interstitial pneumonitis (IP) on surveillance lung biopsy specimens in lung transplant recipients is poorly described, and its impact on posttransplant outcomes is not established. The following study assessed the association of posttransplant IP with the development of bronchiolitis obliterans syndrome (BOS).

Methods:  We examined all recipients of primary cadaveric lung transplants at our institution between January 1, 2000, and December 31, 2007 (N = 145). Patients had bronchoscopies with BAL, and transbronchial biopsies performed for surveillance during posttransplant months 1, 3, 6, and 12 as well as when clinically indicated. Patients were given a diagnosis of IP if, in the absence of active infection and organizing pneumonia, they showed evidence of interstitial inflammation and fibrosis on two or more biopsy specimens.

Results:  IP was a significant predictor of BOS (OR, 7.84; 95% CI, 2.84-21.67; P < .0001) and was significantly associated with time to development of BOS (hazard ratio, 3.8; 95% CI, 1.93-7.39; P = .0001) within the first 6 years posttransplant. The presence of IP did not correlate with a significantly higher risk of mortality or time to death. There was no association between the presence of IP and the development of or time to acute rejection.

Conclusions:  The presence of IP on lung transplant biopsy specimens suggests an increased risk for BOS, which is independent of the presence of acute cellular rejection.

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