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Blood Eosinophilia Predicts Poor Outcome in Lung Transplant Recipients.

Tijdschriftbijdrage - Tijdschriftartikel

PURPOSE: Eosinophils are associated with the onset of chronic respiratory diseases like asthma and COPD. In lung transplantation, patients with increased bronchoalveolar lavage eosinophils demonstrated a worse chronic lung allograft dysfunction (CLAD)-free survival and overall survival. We investigated the association between blood eosinophilia, graft survival and CLAD-free survival after lung transplantation. METHODS: A retrospective analysis was performed including all transplanted patients within our center between 2011 and 2016 (n=376). Blood eosinophils were measured as part of the routine clinical follow-up including all measurements prior to 01/06/2019. A ROC analysis was performed to define cut-offs for blood eosinophilia and patients were subsequently divided in those with high blood eosinophilia vs. those with lower eosinophilia based on the defined cut-off. All patients received oral steroids as part of their standard immunosuppressive drug regimen. RESULTS: ROC analysis revealed that the optimal threshold for blood eosinophilia is >7.85% (p=0.0026) for overall survival and >7.75% (p=0.001) for CLAD-free survival. Using a threshold of >8%, 112 patients had high blood eosinophilia and 264 had low eosinophilia (16 patients developed high eosinophilia after CLAD). Patients with blood eosinophilia >8% demonstrated worse graft survival (p=0.004) and CLAD-free survival (p=0.0076) compared to those with lower blood eosinophilia. Within the high eosinophilia group, 65 (58%) patients were diagnosed with CLAD, of which 42 (37.5%) patients had BOS and 23 (20.5%) had RAS. In the group with lower eosinophilia, 80 (30.3%) patients developed CLAD with 71 (26.9%) BOS and 9 (3.4%) RAS (p<0.0001). CONCLUSION: Lung transplant recipients with high blood eosinophilia (>8%) demonstrate inferior graft survival and CLAD-free survival, specifically RAS. These findings require further research and may lead to the development of an easy to use, non-invasive marker for poor transplant outcome.
Tijdschrift: JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN: 1053-2498
Issue: 4S
Volume: 39
Pagina's: S305
Jaar van publicatie:2020