F-020ROLE OF CYTOKINE PROFILE IN THE DIFFERENTIAL DIAGNOSIS BETWEEN CLINICAL ACUTE LUNG REJECTION AND PULMONARY INFECTIONS AFTER LUNG TRANSPLANTATION

• Published in: Interactive cardiovascular and thoracic surgery 2014-06, Vol.18 (suppl_1), p.S5-S6
• Main Authors: Patella, Miriam, Anile, M., Diso, D., Porto, P. Del, Pecoraro, Y., Onorati, I., Mantovani, S., Giacomo, T. De, Ascenzioni, F., Venuta, F.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu167.20

Objectives: Acute lung rejection (ALR) is a relatively frequent condition during the first year after lung transplantation (LT). It is characterized by perivascular/bronchial mononuclear inflammation mediated by several cytokines. Our aim was to monitor during the first year post LT a panel of cytokines extracted by the bronchoalveolar lavage (BAL) and correlate the levels to clinical ALR. Methods: Twenty double-lung transplant recipients were prospectively assessed. Fifteen (75%) were affected by cystic fibrosis (CF). The plan of the study was to collect samples of BAL at 7 different steps (pre-transplant, post-transplant, 1 week, 1, 3 and 6 months and 1 year). A panel of 6 cytokines was analyzed [tumour necrosis factor alfa (TNF-α), interleukin 1 beta (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8), macrophage inflammatory protein 1 alfa (MIP-1α) and interleukin 10 (IL-10)]. We correlated the cytokine levels with clinical ALR episodes, bacterial and cytomegalovirus (CMV) infections. Results: One hundred and thirty-three BAL samples were collected and analyzed (95%). In CF patients the levels of pro-inflammatory cytokines significantly dropped in the post-transplant sample; they increased in the other patients. Four patients (27%) died during the first year (all 6 months after surgery). Nine patients (45%) showed one clinical ALR episode within 6 months, in 6 (30%) a bacterial pneumonia was diagnosed and 5 (25%) developed CMV infection. No differences with the complication rate between CF and non-CF patients were observed. During the infection episodes all pro-inflammatory cytokines increased consensually with low levels of IL-10; in case of ALR, levels of Il-1β and MIP-1α increased significantly (P = 0.01 and P < 0.0001), IL-10 levels were higher compared to the infection episodes (P = 0.03). No significant changes were observed for TNF-α, IL-6 and IL-8. Conclusions: Cytokines profile analyzed in the BAL (IL-1β, MIP-1α and IL-10) seems useful in the differential diagnosis between clinical ALR and infections. Disclosure: No significant relationships.