Bronchoalveolar lavage in lung transplantation. State of the art.

摘要: Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) has become a crucial tool in the management of lung transplant recipients. Detection pulmonary infectious pathogens by culture, cytology, and histology BAL, protected brush specimens, transbronchial biopsies (TBB) is highly effective. Morphologic phenotypological analyses BAL cells may be suggestive for certain complications after transplantation. For interpretation findings, natural course cell morphology phenotypology transplantation must considered. During first 3 months transplantation, elevated total count neutrophilic alveolitis are common, representing cellular response to graft injury interaction immunocompetent donor recipient origin. With increasing time CD4/CD8 ratio decreases due lowered percentages CD4 BAL. bacterial pneumonias, profile characterized marked granulocytic alveolitis. Lymphocytic decreased acute rejection, but also found viral pneumonias obliterative bronchiolitis. In case combined lymphocytosis neutrophilia without any evidence infection, bronchiolitis should Functional can give additional information about immunologic status graft, even before histologic changes evident have not been established routine monitoring. However, functional studies suggest an important role activated, alloreactive donor-specific T lymphocytes pathogenesis chronic rejection. Investigations soluble components given further insight into processes this overview, characteristics will summarized, its relevance detection discussed.