MONITORING OF ACUTE LUNG REJECTION AND INFECTION BY BRONCHOALVEOLAR LAVAGE AND PLASMA-LEVELS OF HYALURONIC-ACID IN CLINICAL LUNG TRANSPLANTATION

Local immunologic injury caused by acute lung rejection leads to fibro blast proliferation. Hyaluronate is a product of activated fibroblasts and possibly an indicator of fibroblast proliferation. One hundred th irty-six bronchoalveolar lavage and plasma hyaluronate assays were per formed in 57 lung transplant recipients. Pulmonary endothelial cell fu nction was assessed by measuring bronchoalveolar lavage levels of puri ne nucleoside phosphorylase. Presence of acute cellular rejection was monitored by transbronchial biopsy histologic evaluation and was class ified as minimal to mild (acute rejection I, II) and moderate to sever e (acute rejection III, IV). Infection was confirmed by bronchoalveola r lavage culture and antibiotic sensitivity. Bronchoalveolar lavage hy aluronate levels in clinically stable recipients were 33.5 +/- 4.69 mu g/L and were significantly higher than with clinically stable recipien ts (p = 0.0001), infection (p = 0.008), or mild rejection (p = 0.001). Levels were highest in recipients with diffuse alveolar damage (392.4 +/- 60.6 mug/L). Diffuse alveolar damage also resulted in significant elevations of plasma HA as compared with stable recipients (p = 0.001 ) and mild rejection. We conclude that clinically significant injury t o the allograft from rejection or diffuse alveolar damage can be asses sed by bronchoalveolar lavage hyaluronate assays and suggest that the source of hyaluronate in these instances are activated fibroblasts.