Eosinophilia Associated Chronic Lung Allograft Dysfunction: A New Phenotype?

Abstract

Purpose Marked eosinophilia is seldom observed after lung transplantation. Among 181 adult transplanted patients followed for more than 6 months we recently observed 4 patients who developped a chronic lung allograft disfunction (CLAD) associated with alveolar eosinophilia. Methods and Materials From 07/15/88 to 12/31/11, 181 adults (>16 years; 108 M/73F; 75 double lung, 75 single lung and 31 heart lung ) patients were transplanted. Initial diagnosis included: cystic fibrosis and bronchiectasis in 30%; emphysema in 24%; primary pulmonary hypertension in 18%. interstitial lung diseases in 16%. Charts were retrospectively reviewed allowing to identify 47 patients who developped a BOS ≥1 and 10who presented with Restrictive Allograft Syndrome (RAS) CT scan findings. Interestingly enough ta blood and/or eosinophilia was noticed in 4 of these patients was abnormal at the time of diagnosis of CLAD. Results Between 2005 and 2011, a 58 year old female with a bronchiolo alveolar carcinoma, a 31 year old male with cystic fibrosis, a 45 years old male with idiopathic pulmonary fibrosis and pulmonary hypertension, all underwent double lung transplantation and a 64 year old male with idiopathic pulmonary fibrosis underwent a single lung transplant. With a mean delay of 976 days the diagnosis of CLAD was made on the basis of decreased FEV1, 2 had a BOS1, in addition, RAS type CT scan findings were observed in 2. At the time of diagnosis of the CLAD in all of these 4 patients a BAL eosinophilia was observed (mean value: 27%). No known cause of alveolar eosinophila could be detected; 2 of the patients had a marked blood eosinophilia (respectively 12 and 14%). Conclusions In conclusion, alveolar eosinophilia associated CLAD seems to be a phenotype of CLAD.