SaLUTaRy: Survey of lung transplant rejection

Gordon, Ilyssa O.; Bhorade, Sangeeta; Vigneswaran, Wickii T.; Garrity, Edward R.; Husain, Aliya N.

doi:10.1016/j.healun.2012.05.014

Cited by 17 publications

(19 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to acute perivascular (grade A) rejection, treatment for lymphocytic bronchiolitis/bronchitis is currently not standardized due to the fact that adequate sampling and histologic grading of the affected airways is difficult, inconsistent and poorly reproducible, which obscures implementation of therapeutic guidelines . Inhaled budesonide might be useful in controlling posttransplant airway inflammation .…”

Section: Introductionmentioning

confidence: 99%

Azithromycin and the Treatment of Lymphocytic Airway Inflammation After Lung Transplantation

Vos

Verleden

Ruttens

et al. 2014

American Journal of Transplantation

View full text Add to dashboard Cite

Lymphocytic airway inflammation is a major risk factor for chronic lung allograft dysfunction, for which there is no established treatment. We investigated whether azithromycin could control lymphocytic airway inflammation and improve allograft function. Fifteen lung transplant recipients demonstrating acute allograft dysfunction due to isolated lymphocytic airway inflammation were prospectively treated with azithromycin for at least 6 months (NCT01109160). Spirometry (FVC, FEV1, FEF25–75, Tiffeneau index) and FeNO were assessed before and up to 12 months after initiation of azithromycin. Radiologic features, local inflammation assessed on airway biopsy (rejection score, IL‐17+ cells/mm2 lamina propria) and broncho‐alveolar lavage fluid (total and differential cell counts, chemokine and cytokine levels); as well as systemic C‐reactive protein levels were compared between baseline and after 3 months of treatment. Airflow improved and FeNO decreased to baseline levels after 1 month of azithromycin and were sustained thereafter. After 3 months of treatment, radiologic abnormalities, submucosal cellular inflammation, lavage protein levels of IL‐1β, IL‐8/CXCL‐8, IP‐10/CXCL‐10, RANTES/CCL5, MIP1‐α/CCL3, MIP‐1β/CCL4, Eotaxin, PDGF‐BB, total cell count, neutrophils and eosinophils, as well as plasma C‐reactive protein levels all significantly decreased compared to baseline (p < 0.05). Administration of azithromycin was associated with suppression of posttransplant lymphocytic airway inflammation and clinical improvement in lung allograft function.

show abstract

Section: Introductionmentioning

confidence: 99%

Azithromycin and the Treatment of Lymphocytic Airway Inflammation After Lung Transplantation

Vos

Verleden

Ruttens

et al. 2014

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…Importantly, the vexed matter of between-operator biopsy grading variability has at last stimulated a potential solution and this is one of the most exciting aspects to come out of the working group. 4 The set-up and use of a histology digital system to allow online biopsy grading should go a long way toward improving kappa scores between pathologists and, if properly utilized as a self-assessment tool, within pathologist scores.…”

mentioning

confidence: 99%

Antibody-mediated rejection in lung transplantation: Turning myth into reality

Glanville

2013

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

“…17 It has proven difficult to obtain uniformity of reporting despite several well written and well illustrated position papers. 18 This article does not deal with the specifics of the grading criteria because this is covered in article "Acute Cellular and Antibody-Mediated Allograft Rejection" of this issue, but in brief, according to International Society for Heart and Lung Transplantation (ISHLT) criteria, acute cellular rejection is determined by the intensity of perivascular lymphocytic infiltrates (A grades) and peribronchiolar lymphocytic infiltrates (B grades) with scores of 0 ¼ nil, 1 ¼ minimal, 2 ¼ mild, 3 ¼ moderate, 4 ¼ severe, and x ¼ unable to be assessed due to lack of sufficient tissue such as the lack of sufficient bronchiolar epithelium to allow the determination of a B grade. 6,7 Over time it has become apparent that even minimal AR (grade A1) can portend a poor prognosis with respect to the development of bronchiolitis obliterans syndrome (BOS).…”

Section: Why We Should Do Surveillance Procedures Rejection and Lymphmentioning

confidence: 99%

“…Also, despite the best attempts of the ISHLT to define grades of rejection clearly and succinctly it would appear there is a diversity of clinical practice, one sequela of which is that different units de-scribe different outcomes and rates of rejection despite using similar therapies. This issue of between-operator variability in biopsy grading 18 has at last stimulated a potential solution, which is one of the most exciting ideas put forth by the working group. 30 The setup and use of a histological digital system to allow online biopsy grading should go a long way toward improving kappa scores between pathologists and, if properly used as a self-assessment tool, within pathologists' scores.…”

Section: Grading Of Biopsiesmentioning

confidence: 99%

The Role of Surveillance Bronchoscopy Post-Lung Transplantation

Glanville

2013

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Surveillance bronchoscopies with transbronchial lung biopsies (TBBx) are often performed post-lung transplantation, but the clinical value and impact on outcomes remain controversial. Given the cost and risks associated with TBBx, some centers only perform bronchoscopy for specific clinical indications or events. Although the presence of specific histological features (especially acute cellular rejection or lymphocytic bronchiolitis) have been associated with higher risk of chronic lung allograft rejection, the routine use of mandated TBBx has not been shown to alter clinical outcomes. However, prospective, randomized studies have not been done. Further, there are limited published data regarding the value of performing follow-up TBBx to ensure resolution of prior rejection events. On the other hand, putative benefits of TBBx include the ability to fine tune immune suppression and detect infection and large airway stenoses that may require more aggressive measures to minimize development of strictures and thereby prevent downstream post obstructive bronchiectasis. This review discusses the technique of TBBx, histological criteria for allograft rejection (acute and chronic), complications associated with TBBx (particularly pneumothoraces, hypoxemia, and bleeding), and putative benefits associated with mandated surveillance TBBx in this complex patient population.

show abstract

SaLUTaRy: Survey of lung transplant rejection

Cited by 17 publications

References 31 publications

Azithromycin and the Treatment of Lymphocytic Airway Inflammation After Lung Transplantation

Azithromycin and the Treatment of Lymphocytic Airway Inflammation After Lung Transplantation

Antibody-mediated rejection in lung transplantation: Turning myth into reality

The Role of Surveillance Bronchoscopy Post-Lung Transplantation

Contact Info

Product

Resources

About