Tikkanen J, Lemström K, Halme M, Pakkala S, Taskinen E, Koskinen P
Cardiopulmonary Research Group of Transplantation, Laboratory, University of Helsinki and Helsinki University Central Hospital, Finland.
Clin Transplant. 2001 Apr;15(2):77-88. doi: 10.1034/j.1399-0012.2001.150201.x.
Acute rejection and cytomegalovirus (CMV) infection are important complications after lung and heart--lung transplantation. We sought to investigate whether acute rejection and CMV infection demonstrated as CMV antigenemia had an effect on the cell profiles of peripheral blood (PB), bronchoalveolar lavage fluid (BAL-F), or TBB histology.
In this prospective study, composition of cells in PB, BAL-F, and TBB samples from 20 lung or heart-lung transplantation patients were analyzed during episodes of acute rejection or CMV antigenemia. Rejection was graded according to the International Society for Heart and Lung Transplantation criteria. As controls, samples with no evidence of rejection or infection were used. To evaluate the effect of time on cellular findings, samples were divided into three groups according to time after transplantation: 1--30, 31--180, and more than 180 d after transplantation.
Acute rejection was associated with mild blood basophilia (p<0.05; specificity 94%, sensitivity 42%). In BAL-F during rejection, the number of basophils (p<0.05), eosinophils (p<0.05), and lymphocytes (p<0.05; specificity 77%, sensitivity 64%) was increased compared to controls during the post-operative month 1. Later-occurring rejections were associated with increased amounts of neutrophils in BAL-F (p<0.05; specificity 82%, sensitivity 74%). In TBB histology, acute rejections were associated with perivascular and/or peribronchial infiltration of lymphocytes (p<0.001) and plasma cells (p<0.05) compared to controls. In our patients receiving gancyclovir prophylaxis, CMV antigenemia did not significantly alter the cell profiles in PB and BAL-F nor the inflammatory cell picture in TBB histology.
TBB histology remains the 'gold standard' for diagnosing rejection in lung and heart-lung transplantation patients, as the inflammatory cell findings in TBB specimens are highly specific for rejection. The cellular changes associated with rejection, mild PB basophilia and increased proportions of lymphocytes in early- and neutrophils in later-occurring rejection, observed in BAL-F cannot be considered specific for rejection, but may warrant clinical suspicion of rejection.
急性排斥反应和巨细胞病毒（CMV）感染是肺移植和心肺移植后的重要并发症。我们试图研究急性排斥反应和表现为CMV抗原血症的CMV感染是否会对外周血（PB）、支气管肺泡灌洗液（BAL-F）或经支气管活检（TBB）组织学的细胞谱产生影响。
在这项前瞻性研究中，对20例肺移植或心肺移植患者在急性排斥反应或CMV抗原血症发作期间的PB、BAL-F和TBB样本中的细胞组成进行了分析。根据国际心肺移植学会标准对排斥反应进行分级。作为对照，使用无排斥反应或感染证据的样本。为了评估时间对细胞结果的影响，根据移植后的时间将样本分为三组：移植后1 - 30天、31 - 180天和超过180天。
急性排斥反应与轻度血液嗜碱性粒细胞增多有关（p<0.05；特异性94%，敏感性42%）。在排斥反应期间的BAL-F中，与术后第1个月的对照组相比，嗜碱性粒细胞数量（p<0.05）、嗜酸性粒细胞数量（p<0.05）和淋巴细胞数量（p<0.05；特异性77%，敏感性64%）增加。后期发生的排斥反应与BAL-F中中性粒细胞数量增加有关（p<0.05；特异性82%，敏感性74%）。在TBB组织学中，与对照组相比，急性排斥反应与淋巴细胞（p<0.001）和浆细胞（p<0.05）的血管周围和/或支气管周围浸润有关。在接受更昔洛韦预防的患者中，CMV抗原血症并未显著改变PB和BAL-F中的细胞谱，也未改变TBB组织学中的炎症细胞情况。
TBB组织学仍然是诊断肺移植和心肺移植患者排斥反应的“金标准”，因为TBB标本中的炎症细胞发现对排斥反应具有高度特异性。在BAL-F中观察到的与排斥反应相关的细胞变化，即轻度PB嗜碱性粒细胞增多以及早期排斥反应中淋巴细胞比例增加和后期排斥反应中中性粒细胞比例增加，不能被认为是排斥反应的特异性表现，但可能值得临床怀疑排斥反应。
