• Daniel C Chambers, Sandra Hodge, Greg Hodge, Stephanie T Yerkovich, Fiona D Kermeen, Paul Reynolds, Mark Holmes, and Peter M A Hopkins.
• Queensland Centre for Pulmonary Transplantation and Vascular Disease, The Prince Charles Hospital, Brisbane, Queensland, Australia. daniel_chambers@health.qld.gov.au
• J. Heart Lung Transplant. 2011 May 1;30(5):544-51.

BackgroundLymphocytic bronchiolitis (LB) is the strongest risk factor for subsequent allograft loss due to bronchiolitis obliterative syndrome (BOS); however, it is poorly assessed by transbronchial biopsy (TBBx) because of sampling error, interpretation error and the presence of non-alloimmune airway inflammation. We hypothesized that flow cytometric evaluation of bronchiolar brushings (transbronchial brush, TBBr) may be a better approach.MethodsTransbronchial brushings (2 to 3 cm from the pleural surface under radiologic guidance) were obtained prior to TBBx in 32 patients and analyzed by flow cytometry. We assessed the proportion of nucleated cells that were CD3(+)CD103(+) (epithelial-specific T cells).ResultsNo adverse events occurred; 0.5% (0.27 to 0.84) of the cells were epithelial-specific T cells and numbers increased with episodes of Grade A1 rejection (p < 0.01) and in patients with BOS (p = 0.02). Viral and invasive fungal infection were associated with marked infiltration with CD103(-) T cells (p < 0.01).ConclusionTBBr is simple to obtain, low risk, quantitative, and can discriminate between infective and alloimmune LB. It may be a valuable addition to current lung allograft assessment.Copyright © 2011 International Society for Heart and Lung Transplantation. All rights reserved.

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