AIRWAY VERSUS TRANSBRONCHIAL BIOPSY AND BAL IN LUNG-TRANSPLANT RECIPIENTS - DIFFERENT BUT COMPLEMENTARY

Lung transplantation is now an established therapeutic intervention fo r end-stage cardiopulmonary disease in humans. Chronic reflection. in the form of bronchiolitis obliterans syndrome (BOS), remains the commo nest cause of morbidity and mortality in those surviving more than 3 m onths, The pathology of BOS involves airway changes, We have evaluated the potential for endobronchial biopsies (EBB) to complement existing sampling methods used in allograft monitoring and have compared the r esults of EBB findings with those of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) in 18 clinically stable patients, We found that all the EBB had inflammatory cells present but that only five TB B specimens had evidence of inflammation, with airway material being p resent in 78% of the TBB. Paired BAL and EBB yielded different results , with no correlations between total macrophages, lymphocytes, CD4+ ce lls or CD8+ cells, We conclude that endobronchial biopsies are potenti ally useful as an additional sample for the monitoring of inflammation in lung allografts, since they yield different, and potentially compl imentary, information to bronchoalveolar lavage and transbronchial bio psy.