INFLAMMATORY CELLS AND ACTIVATION MARKERS IN BAL DURING ACUTE REJECTION AND INFECTION IN LUNG-TRANSPLANT RECIPIENTS - A PROSPECTIVE, LONGITUDINAL-STUDY

Acute rejection of the transplanted lung is a clinical problem, since it decreases graft survival and predisposes the patient to chronic rej ection and obliterative bronchiolitis (OB),In an earlier study, we had indications that eosinophil cationic protein (ECP) from activated eos inophils and hyaluronan (HYA) from fibroblasts were associated with ac ute pulmonary rejection, This prospective longitudinal study was desig ned to investigate whether molecules from activated inflammatory cells in bronchoalveolar lavage (BAL) fluid could serve as clinically usefu l diagnostic markers for acute rejection, BAL fluid from 138 bronchosc opies performed in 10 single lung, four bilateral lung and five heart- lung transplant recipients were analysed, Nine patients were studied f or a period of more than 1 yr (mean 13.4 months) after surgery, Differ ential cell counts were made from the BAL fluid, ECP, myeloperoxidase (MPO), HYA and interleukin-8 (IL-8) were used as indirect markers for activation and attraction of eosinophils, neutrophils and fibroblasts, respectively, Fifty four episodes of acute rejection were diagnosed, Two patients developed OB, Nine episodes of bacterial infection, 13 ep isodes of cytomegalovirus (CMV) pneumonitis, three of Pneumocystis car inii infection and one of respiratory syncytial virus (RSV) infection were diagnosed, The mean levels of ECP, MPO, HYA and IL-8 were all hig her during rejection episodes, but differences were not statistically significant compared to no rejection, when the confounding factors of time, concomitant infection, and repeated measures in the same individ ual had been accounted for, We could not confirm that measurements of eosinophil cationic protein, myeloperoxidase, hyaluronan and interleuk in-8 in bronchoalveolar lavage fluid can be used as diagnostic markers for acute rejection in the postoperative follow-up of lung transplant recipients.