Longitudinal profile of bronchoalveolar lavage cell characteristics in patients with a good outcome after lung transplantation.

Bronchoalveolar lavage fluid (BALF) analysis is used in patients after lung transplantation (LTX) to obtain more insight into pathological conditions such as acute and chronic allograft rejection. Information on the normal course of BALF cell characteristics in patients with "good outcome" after LTX is limited. Therefore we analyzed 169 BALF samples from 63 well-defined "good outcome" patients after LTX (no acute or chronic transplant dysfunction, bacterial, fungal, or viral infections at the time of BAL). Total cell count decreased from the first months: median (range) 234 x 10(3) (70-610) cells/ml to 103 x 10(3) (10-840) cells/ml during the second year posttransplantation (p < 0.001). Cell differential counts did not change during the 2-yr study period. The CD4/CD8 ratio increased significantly from 0.32 (0.11-0.46) just posttransplantation to 0.62 (0.16-4.27) the second year after LTX. This increasing ratio was mainly due to a sharp decreasing CD8(+) cell count. Thus, characteristics of BAL cellular patterns in patients with good outcomes after LTX show important changes over time. We have defined control values for the BALF cellular profile in patients without pathological airway conditions after LTX. We propose to use these control values as a tool for diagnosing patients with pulmonary complications after LTX and for the follow-up of treatment regimens.