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The Prognostic Importance of Bronchoalveolar Lavage Fluid CXCL9 During Minimal Acute Rejection on the Risk of Chronic Lung Allograft Dysfunction
Author(s) -
Shino M. Y.,
Weigt S. S.,
Li N.,
Derhovanessian A.,
Sayah D. M.,
Saggar R.,
Huynh R. H.,
Gregson A. L.,
Ardehali A.,
Ross D. J.,
Lynch J. P.,
Elashoff R. M.,
Belperio J. A.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14397
Subject(s) - medicine , bronchoalveolar lavage , biomarker , hazard ratio , confidence interval , gastroenterology , single center , lung transplantation , retrospective cohort study , lung , surgery , biochemistry , chemistry
The clinical significance and treatment strategies for minimal acute rejection (grade A1), the most common form of acute rejection ( AR ), remain controversial. In this retrospective single‐center cohort study of 441 lung transplant recipients, we formally evaluate the association between minimal AR and chronic lung allograft dysfunction ( CLAD ) and test a novel hypothesis using bronchoalveolar lavage (BAL) CXCL 9 concentration during minimal AR as a biomarker of subsequent CLAD development. In univariable and multivariable models adjusted for all histopathologic injury patterns, minimal AR was not associated with CLAD development. However, minimal AR with elevated BAL CXCL 9 concentrations markedly increased CLAD risk in a dose–response manner. Minimal AR with CXCL 9 concentrations greater than the 25th, 50th, and 75th percentile had adjusted hazard ratios ( HR s) for CLAD of 1.1 (95% confidence interval [CI ] 0.8–1.6), 1.6 (95% CI 1.1–2.3), and 2.2 (95% CI 1.4–3.4), respectively. Thus we demonstrate the utility of BAL CXCL 9 measurement as a prognostic biomarker that allows discrimination of recipients at increased risk of CLAD development after minimal AR . BAL CXCL 9 measurement during transbronchial biopsies may provide clinically useful prognostic data and guide treatment decisions for this common form of AR , as a possible strategy to minimize CLAD development.