Transforming growth factor beta (TGF-beta) and obliterative bronchiolitis following pulmonary transplantation

Background: Obliterative bronchiolitis (OB) characterised by small-airway f ibrosis is a major cause of morbidity and mortality after lung transplantat ion. TGF-beta has been implicated in the pathogenesis of fibrosis. Methods: We immunohistochemically examined 380 transbronchial biopsies (fro m 91 pulmonary transplants) using TGF-beta polyclonal antibodies. OB and in terstitial fibrosis were diagnosed and graded in all biopsies. Other potent ial histologic and clinical risk factors for OB were analysed. Results: Procedures were heart and lung (n = 32), bilateral sequential lung (n = 18), and single lung transplantation (n = 41). The incidence of OB in this group was 28.5%, In all patients with. OB, TGF-beta was immunolocaliz ed in the airways and lung parenchyma. TGF-beta expression was greater in O B patients (median score 8, range 5-12) in comparison to patients without O B (median score 4, range 1-13), p < .0001. Positive TGF-beta staining prece ded the histologic confirmation of OB by 6 to 18 months. The development of OB was associated with two HLA mismatches at the A locus (p = .02); recurr ent acute rejection episodes (p < .0005); lymphocytic bronchiolitis (p = .0 001); and tissue eosinophilia, regardless of the rejection graded (p < .000 1). Conclusions: Increased expression of TGF-beta is a risk factor for the deve lopment of OB. Other risk factors are recurrent acute rejection, lymphocyti c bronchiolitis, tissue eosinophilia, and two mismatches at the HLA-A locus . This suggests that the pathogenesis of progressive small airway fibrosis characteristic of OB may be inflammatory damage, followed by an aberrant re pair process due to excessive TGF-beta production following allograft injur y. Hence, modulation of TGF-beta levels or function by antagonists may repr esent an important approach to control OB.