Irène Frachon

Emergence of inflammatory alveolar macrophages during rejection or infection after lung transplantation.

Local activation of macrophages may play an important role in immune complications following lung transplantation. To document such a phenomenon, we have investigated the possible changes of alveolar macrophage surface antigen expression after lung transplantation. Using immunocytofluorometry, we have analyzed the phenotype of alveolar macrophages from 41 bron-choalveolar lavage fluids obtained from 19 lung transplant recipients displaying various complications. The strong expression of HLA-DR observed on almost all alveolar macrophages was similar among groups I (no complication), II (minimal acute rejection), and III (mild to severe acute rejection), but was enhanced in group IV (bronchial infection) (P<0.03). We observed no significant variation in the monocyte lineage CD14 antigen expression among the 4 groups, and about 83% of alveolar macrophages expressed this marker strongly. Membrane expression of the 27E10 antigen that characterizes infiltrating macrophages in acute inflammatory lesions was significantly higher during mild to severe rejection episodes than in controls (P<0.02) and during bronchial infections (P<0.05) but not during minimal rejection. Double staining experiments confirmed that 27E10-positive cells in groups III and IV belonged to the macrophage lineage. In addition, the expression of the 27E10 antigen on cultured alveolar macrophages was found to be increased after stimulation by bacterial lipopolysaccharide or IFN-γ.

Particular phenotypic profile of blood lymphocytes during obliterative bronchiolitis syndrome following lung transplantation.

Bronchiolitis obliterans syndrome (OBS) remains the major complication in long-term survivors with heart-lung transplants, occurring in up to 50% of patients who survived the first year postsurgery. Until now, a significant decrease in small airway flow parameters has represented the most sensitive index for the detection of early OBS. Using immunocytofluorometric analysis, in a prospective study we have analysed the phenotype of peripheral blood lymphocyte effector and regulatory subsets in seven patients with inactive well-established OBS as compared with lung transplant recipients without any complication. We found a particular phenotypic profile during well-established OBS characterized by: (1) the disappearance of the CD19+ B cell population despite normal or increased immunoglobulin blood levels; (2) a marked decrease in the CD4+/CD8+ ratio; (3) a dramatic increase in phenotypic cytotoxic effector T cells CD8+S6F1+high and CD3+CD4-CD8-; (4) a dramatic increase in the CD4+CD29+/CD4+CD45RA+ ratio associated with the loss of the phenotypic suppressor/inducer CD4+CD45RA+T cells. The results of this preliminary study suggest that, using this selected combination of lymphocyte membrane markers, sequential phenotyping could be useful in the noninvasive follow-up of lung transplant recipients. The predictive value of this phenotypic profile for the early diagnosis of OBS is under investigation.

[Contraception, therapeutic abortion, and pulmonary arterial hypertension].

Despite therapeutic advances, maternal mortality is high in pulmonary arterial hypertension (PAH). PAH treatment may interfere with the proposed method of contraception. Moreover, some treatments (endothelin receptor antagonists, anti-vitamin K) are teratogenic. If pregnancy is strictly not recommended in PAH, few specific contraceptive guidelines are available. The contraceptive method must be discussed on a case by case basis with the patient, the reference team for PAH, and the gynecology department.The advantages of the intrauterine device (IUD) with progesterone (reliability, simplicity, compliance, few contraindications and interactions, possibility of use in the nulliparous patient, reimbursement by the healthcare system) make it a good contraceptive choice in these circumstances. Therapeutic abortion is a situation of contraceptive failure, it must always be performed in hospitals. It must lead to effective contraceptive advice.

0499: Predicting post-capillary origin of Pulmonary Hypertension (PH): external validation of the PH Council (PHC) of International Society for Heart and Lung Transplantation (ISHLT) score

Background Determination of the origin (pre or post-capillary) of PH is crucial to guide therapy. Right heart catheterization (RHC) is the gold standard to identify PH origin. However this technique is invasive and may cause complications. The PHC of ISHLT proposes a clinical and echocardiographic score to estimate the origin of PH in order to select patients who truly require RHC. The aim of the study was to evaluate the validity of this score in a real life population of patients with PH. Methods We studied retrospectively clinical, echocardiographic and hemodynamic characteristics of consecutive patients referred to our center to undergo a RHC between January 2005 and August 2013 and evaluated the performance of the PHC prediction score. Results 116 patients with pre capillary PH and 71 with post capillary PH were included.Post capillary PH patients were older(73.2 vs 62.8, p Conclusion The score proposed by the PHC of ISHLT to determine noninvasively the origin of PH is fairly accurate but could be enhanced by the adjunction of AF as a new criterion.

Contraception, interruption de grossesse et hypertension artérielle pulmonaire

Despite therapeutic advances, maternal mortality is high in pulmonary arterial hypertension (PAH). PAH treatment may interfere with the proposed method of contraception. Moreover, some treatments (endothelin receptor antagonists, anti-vitamin K) are teratogenic. If pregnancy is strictly not recommended in PAH, few specific contraceptive guidelines are available. The contraceptive method must be discussed on a case by case basis with the patient, the reference team for PAH, and the gynecology department.The advantages of the intrauterine device (IUD) with progesterone (reliability, simplicity, compliance, few contraindications and interactions, possibility of use in the nulliparous patient, reimbursement by the healthcare system) make it a good contraceptive choice in these circumstances. Therapeutic abortion is a situation of contraceptive failure, it must always be performed in hospitals. It must lead to effective contraceptive advice.

Contraception abortion and pulmonary arterial hypertension

Despite therapeutic advances, maternal mortality is high in pulmonary arterial hypertension (PAH). PAH treatment may interfere with the proposed method of contraception. Moreover, some treatments (endothelin receptor antagonists, anti-vitamin K) are teratogenic. If pregnancy is strictly not recommended in PAH, few specific contraceptive guidelines are available. The contraceptive method must be discussed on a case by case basis with the patient, the reference team for PAH, and the gynecology department.The advantages of the intrauterine device (IUD) with progesterone (reliability, simplicity, compliance, few contraindications and interactions, possibility of use in the nulliparous patient, reimbursement by the healthcare system) make it a good contraceptive choice in these circumstances. Therapeutic abortion is a situation of contraceptive failure, it must always be performed in hospitals. It must lead to effective contraceptive advice.

Diagnostic et prise en charge de l’hypertension pulmonaire postembolique : le rôle du pneumologue

The prognosis of postembolic pulmonary hypertension, a rare and serious disease, has been transformed with the curative intervention of pulmonary endarteriectomy. The screening is based on two key non invasive examinations, the cardiac ultrasound and ventilation-perfusion scintigraphy. The confirmation of the diagnosis and the determination of the best therapeutic options then relies on the expertise of the national reference centre, based on the haemodynamics and the morphological data provided by pulmonary angiography and spiral computerised tomography. Although the technique of endarteriectomy is fully validated, a drug approach is in the assessment process, both in the inoperable forms or when confronted with persistent postsurgical pulmonary hypertension.