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Higher Risk of Acute Cellular Rejection in Lung Transplant Recipients with Cystic Fibrosis

Fiorella Calabrese, Francesca Lunardi, Nazarena Nannini, Elisabetta Balestro, Monica Loy, Giuseppe Marulli, Francesca Calabrese, Stefania Edith Vuljan, Marco Schiavon, Egle Perissinotto, Federico Rea

(Pneumology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy)

Ann Transplant 2015; 20:769-776

DOI: 10.12659/AOT.894785


BACKGROUND: Acute cellular rejection (ACR) affects up to 40% of recipients within the first year after lung transplant (LTx). The aim of this study was to determine the frequency of ACR and associated major risk factors in cystic fibrosis (CF) recipients. Bronchiolitis obliterans syndrome (BOS) and 1-year/long-term survival were also evaluated.
MATERIAL AND METHODS: ACR was reviewed in 643 scheduled biopsies from 44 CF (Group 1) versus 89 other recipients (Group 2). We performed univariate/multivariate analyses of risk factors for ACR and BOS, and survival analysis.
RESULTS: Group 1 showed higher ACR frequency, especially for ACR ≥A2. Multivariable generalized linear models considering both native lung disease and age showed that higher values of ACR index were significantly related to the pretransplant diagnosis of CF. BOS and long-term survival were not influenced by the increased incidence of ACR. Poorer long-term survival was observed in Group 2.
CONCLUSIONS: CF recipients have a higher ACR risk, which may be due to enhanced immune activation related to a genetic disorder, and younger age.

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