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Changes in induced sputum in the presence of bronchiolitis obliterans syndrome and correlation with spirometry in single and bilateral lung transplant recipients

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Abstract

Bronchiolitis obliterans syndrome is a clinical diagnosis based on lung function parameters. Using induced sputum, taken from lung transplant recipients, this paper reports on the correlation between the neutrophil count and the percentage change from postoperative baseline for FEV1, FEF50, and FEF25–75. In double lung transplant recipients the correlations were significant for FEV1 (r = −0.68, p = 0.002), FEF50 (r = −0.65, p = 0.016), and FEF25–75 (r = −0.56, p = 0.016). In single lung transplant recipients, no significant correlations were seen.

Section snippets

Patients

The South Manchester ethics committee approved this study. All transplant recipients were outpatients from the Wythenshawe Transplant Unit, and had given written informed consent. A total of 28 lung transplant recipients were included, comprising 4 heart lung recipients, 8 double lung recipients, and 16 single lung recipients. All these patients were attending the transplant unit for their routine clinic visit and were free from acute rejection and infection (acute or chronic). In total 43

Safety

There were no adverse events during sputum induction. In the transplant recipients the baseline FEV1 pre-induction ranged from 26.4% to 112.9% of the predicted FEV1. A fall in FEV1 of less than 10% was seen during 63.4% of the inductions from the transplant recipients. There was a trend (p = 0.07) towards a greater average fall in FEV1 postsputum induction in lung transplant recipients with BOS grades 1 to 3 (6.6%) compared to the transplant recipients with BOS grade 0 (2.2%).

Correlation with lung function and sputum neutrophilia

For the purpose of

Discussion

We are the first to report a negative correlation between induced sputum neutrophil counts and changes in lung function from best postoperative values, as measured by the FEV1, FEF50, and FEF25–75. Furthermore, we have shown that in the bilateral lung transplant group induced sputum neutrophil percentage and number of leukocytes per gram of induced sputum are significantly higher in the presence of BOS. In the single lung recipients induced sputum results may be affected by the contribution

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    A deterioration in FEV1 may be indicative of multiple problems, such as acute or chronic rejection, infection or hyperinflation of the native lung. FEV1 figures falling by more than 20% from baseline in 2 consecutive measurements obtained in a 3–6-week interval are considered a criterion for bronchiolitis obliterans syndrome (BOS), after other causes, such as infection, acute rejection or changes in bronchial anastomosis, have been ruled out.17,18 In addition, a fall in FEV1 must also be accompanied by a fall in FEV1/FVC, since a fall in FEV1 associated with a restrictive ventilatory deficit is not considered to be BOS.

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