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Lymphocytic bronchitis/bronchiolitis in lung allograft recipients
1Department of Pathology, Montefiore University Hospital, University of Pittsburgh School of Medicine, Pennsylvania 15213-3241.
The American Journal of Surgical Pathology
|May 1, 1993
Summary
Lymphocytic bronchitis/bronchiolitis (LBB) in lung transplant recipients is linked to acute rejection and can progress to bronchiolitis obliterans (OB). However, intensified immunosuppression often improves lung function in LBB patients.
Area of Science:
- Pulmonary Medicine
- Transplantation Immunology
- Pathology
Background:
- Lymphocytic bronchitis/bronchiolitis (LBB) is a condition observed in lung allograft recipients.
- Its relationship with acute rejection and the development of bronchiolitis obliterans (OB) requires further elucidation.
Purpose of the Study:
- To investigate the association between lymphocytic bronchitis/bronchiolitis (LBB) and acute rejection in lung transplant recipients.
- To determine the progression of LBB to bronchiolitis obliterans (OB) and its response to immunosuppressive therapy.
Main Methods:
- Retrospective analysis of 26 cases of LBB diagnosed via transbronchial biopsy in 25 lung allograft recipients.
- Histopathological examination of bronchial submucosal infiltrates and assessment of clinical outcomes.
Main Results:
- LBB occurred a median of 355 days post-transplantation and was characterized by lymphocytic and plasma cell infiltrates.
- A significant proportion of patients with LBB (39%) progressed to OB, which was associated with submucosal granulation tissue and bronchiolitis.
- LBB was preceded by acute rejection in 20 of 26 cases and often persisted histologically.
- The majority of LBB patients receiving augmented immunosuppression (steroids, antithymocyte globulin) showed improved or stabilized pulmonary function.
Conclusions:
- Lymphocytic bronchitis/bronchiolitis (LBB) in lung transplant recipients appears to be related to prior acute rejection episodes.
- LBB is a potential precursor to bronchiolitis obliterans (OB) but often responds favorably to intensified immunosuppressive therapy, leading to improved lung function.