Department of Pulmonology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
Department of Genetics, Cell- and Immunobiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
Immun Inflamm Dis. 2022 Aug;10(8):e673. doi: 10.1002/iid3.673.
After lung transplantation (LuTX), lower respiratory tract infections (LRTI) and acute cellular rejection (ACR) are associated with changes in peripheral blood and bronchoalveolar lavage fluid mononuclear cell profile (PBMC and BALIC). PBMC is also influenced by immunosuppressive regimen and its changes with postoperative time. First-year PBMC and BALIC changes were evaluated in this study with rabbit anti-thymocyte globulin (ATG) and alemtuzumab (AL) induction therapy.
In total, 64 LuTX recipients were included, 53 of them received AL and 11 ATG as induction therapy. PBMC and BALIC were examined routinely and in cases suspicious of infection and/or rejection. A PBMC- and BALIC-based algorithm for infection and rejection prediction was also tested.
In the AL group, peripheral blood lymphocyte and basophil cell numbers were significantly reduced, while the neutrophil cell number elevation during LRTI was significantly higher compared to the control. Early postoperative measurements showed a lower BALIC lymphocyte count. The algorithm had 17% sensitivity and 94% specificity for ACR in all patients and 33% sensitivity and 95% specificity for ACR with coexisting LRTI.
BALIC is not significantly influenced by the immunosuppressive regimen. PBMC- and BALIC-based algorithm may improve the differential diagnosis of ACR.
肺移植（LuTX）后，下呼吸道感染（LRTI）和急性细胞排斥（ACR）与外周血和支气管肺泡灌洗液单核细胞谱（PBMC 和 BALIC）的变化相关。免疫抑制方案也会影响 PBMC，并且其随术后时间的变化而变化。本研究采用兔抗胸腺细胞球蛋白（ATG）和阿仑单抗（AL）诱导治疗，评估了第一年的 PBMC 和 BALIC 变化。
共纳入 64 例 LuTX 受者，其中 53 例接受 AL，11 例接受 ATG 作为诱导治疗。常规检查 PBMC 和 BALIC，并在疑似感染和/或排斥时进行检查。还测试了基于 PBMC 和 BALIC 的感染和排斥预测算法。
在 AL 组中，外周血淋巴细胞和嗜碱性粒细胞数量显著减少，而 LRTI 期间中性粒细胞数量升高更为明显。术后早期测量显示 BALIC 淋巴细胞计数较低。该算法在所有患者中对 ACR 的敏感性为 17%，特异性为 94%，对合并 LRTI 的 ACR 的敏感性为 33%，特异性为 95%。
BALIC 不受免疫抑制方案的显著影响。基于 PBMC 和 BALIC 的算法可能有助于改善 ACR 的鉴别诊断。
