Significance of clinically silent untreated mild acute cellular rejection in lung allograft recipients

Human Pathology
S A Yousem

Abstract

Although acute rejection is a frequent occurrence after transplantation, the clinical behavior and pathological manifestations of untreated mild acute cellular rejection in clinically stable lung allograft recipients is poorly defined. Sixteen patients were identified who had asymptomatic mild acute rejection that was untreated but followed by subsequent pulmonary function tests and repeat transbronchial biopsy. Six patients had spontaneous resolution of their infiltrates; the condition of 10 patients worsened as observed from their biopsies or function studies. Those who worsened had more episodes of acute rejection per patient before the A2 biopsy (2.0 vs 1.3), and 50% developed bronchiolitis obliterans compared with 16% in the spontaneously regressing group. Pathological evaluation showed that patients with persistent or worsening untreated A2 rejection tended to have more large and small airway inflammation, larger numbers of eosinophils and plasma cells in their biopsies, and airway and airspace granulation tissue. These variables may be used to help determine which low grade lung rejection episodes should receive adjunctive immunosuppressive therapy.

References

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Citations

Apr 23, 2011·Clinics in Chest Medicine·Christiane Knoop, Marc Estenne
Oct 17, 2009·Medicina intensiva·A González CastroE Miñambres
Apr 24, 2007·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Gregory I SnellSusan Stewart
Nov 3, 2005·Clinics in Chest Medicine·Timothy P M Whelan, Marshall I Hertz
Feb 11, 2005·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Dong-Won KimSamuel A Yousem
Apr 17, 1999·Clinics in Chest Medicine·E P Trulock
Jun 1, 1997·Clinics in Chest Medicine·M B King-Biggs
Nov 25, 2000·Clinical Transplantation·K ShomoriH Ito
May 17, 2007·Current Opinion in Pediatrics·Gary A Visner, Samuel B Goldfarb
Jul 21, 2009·Current Opinion in Organ Transplantation·Ramsey R Hachem
Mar 21, 1998·The American Journal of Surgical Pathology·L FinnE Yunis
Jul 7, 2019·La Radiologia medica·Ambra Di PiazzaRoberto Miraglia
Oct 8, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·David R DarleyTereza Martinu

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