Detecting Acute Lung Rejection and Infection Following Heart-Lung Transplantation: RESULTS
A total of 38 transbronchial biopsies were carried out in the 15 HLT recipients during the period under review. Twenty (52.6 percent) of these showed acute lung rejection. Nine (23.7 percent) demonstrated evidence of infection, of which six were cytomegalovirus (CMV) pneumonia, two were bacterial bronchitis, and one was herpes simplex pneumonitis. The remaining nine biopsy specimens had a normal appearance histologically.
The mean (±SD) values of FEV, and FVC as recorded at home by the patients at the time of the acute rejection episodes were 2.27 ±1.2 L and 2.72 ± 1.3 L, respectively. Corresponding values during infection episodes and also during normal biopsies are shown in Table 1.
Figure 3. Individual FEV, recordings in the 20 episodes of rejection. В indicates before rejection; D, during rejection. In all cases, a fall in FEV, was sustained.
A mean (±SD) fall of 0.23 ±0.2 L occurred in the FEV! during rejection, representing 10.4 ±6.9 percent decrease from the prerejection values. During the infection episodes, similar decreases were sustained in the FEV, and FVC, the former falling by a mean 12.8 ±10.1 percent (Table 2). The individual changes in FEV! during acute rejection are shown in Figure 3 and those during infection are shown in Figure 4.
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Table 1—Mean (± SD) Spirometric Values During Lung Biopsies
|
|
FEV,, L |
FVC, L |
|
Rejection (n = 20) |
2.27± 1.2 |
2.75± 1.3 |
|
Infection (n = 9) |
1.64 ±0.6 |
2.08 ± 1 |
|
Normal (n = 9) |
2.65 ±0.7 |
3.14 ±0.9 |
All the patients had a transbronchial biopsy within one week of the onset of decline in FEV, at home. The mean duration between onset of decline in FEV, and transbronchial biopsy during the rejection episodes was 3.25 ±2 days. Similarly biopsy specimens confirming infection were carried out a mean 3.4 ±2 days from the period the FEV, started to fall.
Figure 4. Recordings of FEV, before (B) and during (D) the nine episodes of opportunistic infection. There was a decline in FEV, with infection in all cases.
In nine patients the daily FEV, did not vary. However, six of the 15 patients had a total of 22 occasions when temporary falls in FEV, occurred without development of symptoms. The mean fall in FEV, at these times was 8.4 ±3.5 percent rising back to normal spontaneously within a mean of 1.9 ± 1 days.
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Table 2—Mean (± SD) Decreases in Spirometry During Rejection and Infection
|
|
FEV,, L |
FVC, L |
|
Rejection |
|
|
|
Change in liters |
0.23 ±0.2 |
0.24 ±0.2 |
|
% change |
10.4 ±6.9 |
9.26 ±7.9 |
|
Infection |
|
|
|
Change in liters |
0.24 ±0.2 |
0.28±0.3 |
|
% change |
12.8 ±10.1 |
12.49 ±14.3 |
