SMOKERS LUNG TRANSPLANTED TO A NONSMOKER - LONG-TERM DETECTION OF SMOKERS MACROPHAGES

Alveolar macrophages (AM) from smokers contain characteristic smoker's inclusion bodies within the cytoplasm as a result of ingestion of sub stances in the inhaled smoke. How long these smoking-related changes i n the AM population can be seen after smoking cessation is largely unk nown. We had the unique opportunity to investigate a 51-yr-old never-s moker after single lung transplantation (TX) for alpha 1-antitrypsin d eficiency emphysema who received a donor's lung from a heavy cigarette smoker. Serial bronchoalveolar lavage (BAL) was performed in the dono r's lung for transplant surveillance at defined time intervals, and th e percentage of AM with characteristic smoker's inclusions was counted on slides stained with May-Grunwald-Giemsa stain. The patient had an uneventful course after TX with no major infectious complications or e pisodes of rejection. One month after TX the percentage of smoker's AM was 98%. BAL after 2, 5, 7, and 12 mo showed a similar high percentag e. After 18 mo a first a decrease was seen, down to 78%, and after 2 y r a decrease to 59% was seen. After 3 yr, the smoker's AM had mostly d isappeared, only 3% were still present. In conclusion, smoker's inclus ions in AM may be detected for at least 2 yr after smoking has ceased, which is considerably longer than the estimated life span of the AM.