BACKGROUND: Eosinophils are involved in the pathophysiology of many respiratory diseases, but the exact role of eosinophilia in lung transplantation has not been thoroughly investigated. METHODS: We performed a retrospective analysis of our transplanted patients between 2001 and 2011, with a minimum follow-up of 1 year. Using a cutoff of ≥2% eosinophilia in bronchoalveolar lavage (BAL) fluid, chronic lung allograft dysfunction (CLAD)-free survival and overall survival was compared between 66 patients demonstrating at least one BAL with eosinophils ≥2% and 253 control patients (never BAL ≥2%). RESULTS: Patients with increased BAL eosinophilia demonstrated worse CLAD-free and overall survival (both P<0.0001) compared with controls. Eosinophilic BAL predisposed to development of bronchiolitis obliterans syndrome but particularly to restrictive allograft syndrome (P<0.0001). After correction for covariates, the association between eosinophilic BAL and CLAD but equally death remained significant (P=0.0047 and 0.0011). Blood eosinophil and C-reactive protein levels were also elevated at the time of eosinophilic BAL. CONCLUSION: BAL eosinophilia ≥2% is associated with poor outcome in our lung transplant patients as demonstrated by worse CLAD-free and overall survival. Interestingly, increased BAL eosinophilia may be specifically associated with the development of restrictive allograft syndrome, which needs further prospective investigation.
BACKGROUND: Eosinophils are involved in the pathophysiology of many respiratory diseases, but the exact role of eosinophilia in lung transplantation has not been thoroughly investigated. METHODS: We performed a retrospective analysis of our transplanted patients between 2001 and 2011, with a minimum follow-up of 1 year. Using a cutoff of ≥2% eosinophilia in bronchoalveolar lavage (BAL) fluid, chronic lung allograft dysfunction (CLAD)-free survival and overall survival was compared between 66 patients demonstrating at least one BAL with eosinophils ≥2% and 253 control patients (never BAL ≥2%). RESULTS:Patients with increased BAL eosinophilia demonstrated worse CLAD-free and overall survival (both P<0.0001) compared with controls. Eosinophilic BAL predisposed to development of bronchiolitis obliterans syndrome but particularly to restrictive allograft syndrome (P<0.0001). After correction for covariates, the association between eosinophilic BAL and CLAD but equally death remained significant (P=0.0047 and 0.0011). Blood eosinophil and C-reactive protein levels were also elevated at the time of eosinophilic BAL. CONCLUSION: BAL eosinophilia ≥2% is associated with poor outcome in our lung transplant patients as demonstrated by worse CLAD-free and overall survival. Interestingly, increased BAL eosinophilia may be specifically associated with the development of restrictive allograft syndrome, which needs further prospective investigation.
Authors: Hrishikesh S Kulkarni; Wida S Cherikh; Daniel C Chambers; Victoria C Garcia; Ramsey R Hachem; Daniel Kreisel; Varun Puri; Benjamin D Kozower; Derek E Byers; Chad A Witt; Jennifer Alexander-Brett; Patrick R Aguilar; Laneshia K Tague; Yuka Furuya; G Alec Patterson; Elbert P Trulock; Roger D Yusen Journal: J Heart Lung Transplant Date: 2018-09-25 Impact factor: 10.247
Authors: Oscar Okwudiri Onyema; Yizhan Guo; Atsushi Hata; Daniel Kreisel; Andrew E Gelman; Elizabeth A Jacobsen; Alexander Sasha Krupnick Journal: Am J Transplant Date: 2019-11-18 Impact factor: 8.086
Authors: S E Verleden; J L Todd; M Sato; S M Palmer; T Martinu; E N Pavlisko; R Vos; A Neyrinck; D Van Raemdonck; T Saito; H Oishi; S Keshavjee; M Greer; G Warnecke; J Gottlieb; A Haverich Journal: Am J Transplant Date: 2015-04-30 Impact factor: 8.086
Authors: Nancy Y Greenland; Fred Deiter; Daniel R Calabrese; Steven R Hays; Jasleen Kukreja; Lorriana E Leard; Nicholas A Kolaitis; Jeffrey A Golden; Jonathan P Singer; John R Greenland Journal: Clin Transplant Date: 2022-03-12 Impact factor: 3.456