Open AccessHUMAN CYTOMEGALOVIRUS EARLY INFECTION, ACUTE REJECTION, AND MAJOR HISTOCOMPATIBILITY CLASS II EXPRESSION IN TRANSPLANTED LUNG
Author(s) -
Eloisa Arbustini,
Patrizia Morbini,
Maurizia Grasso,
Marta Diegoli,
Roberta Fasani,
Emanuele Porcu,
Nadia Banchieri,
Vittorio Perfetti,
Carlo Pederzolli,
Paolo Grossi,
Daniela Dalla Gasperina,
Luigi Martinelli,
Marco Paulli,
M. Ernst,
Bodo Plachter,
Mario Viganò,
Enrico Solcia
Publication year - 1996
Publication title -
transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.45
H-Index - 204
eISSN - 1534-6080
pISSN - 0041-1337
DOI - 10.1097/00007890-199602150-00018
Subject(s) - bronchoalveolar lavage , immunohistochemistry , immunology , antigen , human cytomegalovirus , pathology , human leukocyte antigen , lung , occult , medicine , biology , virus , alternative medicine
The present study aimed to investigate the relationship between acute rejection and human cytomegalovirus (HCMV) infection, as well as the coexpression of HLA-DR and immediate-early (IE) viral antigens, in 143 transbronchial biopsies and bronchoalveolar lavage fluids of 32 lung transplant recipients. We investigated the occurrence of morphologically overt viral infection with conventional histopathology, the expression of IE antigens with single labeling immunohistochemistry, the coexpression of IE antigens and HLA-DR molecules with double labeling techniques, and the presence of viral IE genes with polymerase chain reaction. Histopathologic study showed overt viral infections (12.6%) in 18 of the 143 biopsies; 8 were in a context of pneumonia and 10 were localizations without surrounding inflammatory cells; immunohistochemistry showed IE viral antigen expression in 31 (21.67%); PCR detected viral IE genes in 73/143 lavage fluids and biopsies (51%). The double labeling immunohistochemical technique showed that most IE antigen-expressing, noncytopathic cells were either HLA-DR negative in areas without infiltrates, or HLA-DR positive in those areas where inflammatory infiltrates were consistent, in the absence of viral cytopathy, with acute rejection. The results indicate that, in transplanted lung, the frequency of morphologically occult HCMV infection (as detected by immunohistochemically and/or PCR) is much higher than that of morphologically overt viral infection. The occurrence of inflammatory infiltrates (consistent with acute rejection) around morphologically occult infected cells and the possible lack of inflammation around both early- and late-infected cells suggest that in biopsies with occult infection the infiltrates should be attributed to allograft reaction. This conclusion would be in keeping with the coexpression of HLA-DR and HCMV IE in infiltrate-rich biopsies that are consistent with acute rejection, as well as with the absence of HLA-DR expression in IE antigen-positive cells in infiltrate-free-areas.