PERIPHERAL EOSINOPHILIA IS ASSOCIATED WITH CHRONIC LUNG ALLOGRAFT DYSFUNCTION

ASHTEN Sherman; JOSALYN L Cho; TAHUANTY A Pena; RAUL A Villacreses; ANURADHA Gore; JULIA A KLESNEY-TAIT; KALPAJ Parekh

doi:10.1016/j.chest.2024.06.3766

PURPOSE: Eosinophils contribute to tissue damage and inflammation in lung diseases including asthma and COPD. Following lung transplant, eosinophilia is observed during acute rejection, and a single European center found an association between peripheral blood eosinophils and chronic lung allograft dysfunction (CLAD) [1,2,3]. We therefore asked whether eosinophilia was associated with lung transplant outcomes in a U.S. center. METHODS: We performed a retrospective analysis of individuals undergoing lung transplantation at the University of Iowa Hospitals and Clinics between January 1, 2006 and December 31, 2023. Participants were included if they had at least 6 months of follow-up data. Peripheral blood eosinophils were analyzed starting three months post-transplant. The maximum eosinophil count was identified and used to classify each participant as having high eosinophils (≥ 300 /mm3) or low eosinophils (< 300 /mm3) [4]. RESULTS: Of the 261 participants (187 male, 74 female) included in the analysis, 101 (38.6%) had low eosinophils and 160 (61.3%) had high eosinophils. The median eosinophil count was 200 cells/mm3 (IQR 140-233) in the low group and 560 cells/mm3 (IQR 411-940) in the high group. No differences were observed between the low and high eosinophil groups in age at transplant, race, or ethnicity. The low eosinophil group had a higher percentage of females (42/101, 41.5%) compared to the high eosinophil group (32/160, 20%; p<0.01). More participants in the low eosinophil group underwent transplant for interstitial lung disease compared to the low eosinophil group (51.4% vs. 35%, p<0.01) while more patients in the high eosinophil group were transplanted for cystic fibrosis compared to the low eosinophil group (7.9% vs. 21%, p<0.01). A greater proportion of participants with high eosinophils developed CLAD (80/160, 50%) compared to those with low eosinophils (31/101, 31%; p<0.01). Participants with high eosinophils had lower CLAD-free (p<0.01) and overall survival (p<0.0001) compared to those with low eosinophils. CONCLUSIONS: High blood eosinophils are associated with lower CLAD-free survival and lower overall survival following lung transplantation. CLINICAL IMPLICATIONS: Monoclonal antibodies targeting eosinophils are effective in treating respiratory diseases driven by eosinophilic inflammation The role of eosinophils in the development of CLAD therefore warrants further investigation and could lead to new therapeutic approaches to improve outcomes following lung transplant.

PERIPHERAL EOSINOPHILIA IS ASSOCIATED WITH CHRONIC LUNG ALLOGRAFT DYSFUNCTION

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