Effects of donor bone marrow infusion in clinical lung transplantation

Background. We have demonstrated that donor cell chimerism is associated wi th a lower incidence of obliterative bronchiolitis (OB) in lung recipients, and that donor chimerism is augmented by the infusion of donor bone marrow (BM). We herein report the intermediate results of a trial combining the i nfusion of donor BM and lung transplantation. Methods. Clinical and in vitro data of 26 lung recipients receiving concurr ent infusion of donor bone marrow (3.0 to 6.0 x 10(8) cells/kg) were compar ed with those of 13 patients receiving lung transplant alone. Results. Patient survival and freedom from acute rejection were similar bet ween groups. Of the patients whose graft survived greater than 4 months, 5% (1 of 22) of BM and 33% (4 of 12) of control patients, developed histologi c evidence of OB (p = 0.04). A higher proportion (but not statistically sig nificant) of BM recipients (7 of 10, 70%) exhibited donor-specific hyporeac tivity by mixed lymphocyte reaction assays as compared with the controls (2 of 7, 28%). Conclusions. Infusion of donor BM at the time of lung transplantation is sa fe, and is associated with recipients' immune modulation and a lower rate o f obliterative bronchiolitis. (C) 2000 by The Society of Thoracic Surgeons.