Transforming growth factor beta (TGF-beta) and obliterative bronchiolitis following pulmonary transplantation

J Heart Lung Transplant. 1999 Sep;18(9):828-37. doi: 10.1016/s1053-2498(99)00047-9.


Background: Obliterative bronchiolitis (OB) characterised by small-airway fibrosis is a major cause of morbidity and mortality after lung transplantation. TGF-beta has been implicated in the pathogenesis of fibrosis.

Methods: We immunohistochemically examined 380 transbronchial biopsies (from 91 pulmonary transplants) using TGF-beta polyclonal antibodies. OB and interstitial fibrosis were diagnosed and graded in all biopsies. Other potential histologic and clinical risk factors for OB were analysed.

Results: Procedures were heart and lung (n = 32), bilateral sequential lung (n = 18), and single lung transplantation (n = 41). The incidence of OB in this group was 28.5%. In all patients with OB, TGF-beta was immunolocalized in the airways and lung parenchyma. TGF-beta expression was greater in OB patients (median score 8, range 5-12) in comparison to patients without OB (median score 4, range 1-13), p < .0001. Positive TGF-beta staining preceded the histologic confirmation of OB by 6 to 18 months. The development of OB was associated with two HLA mismatches at the A locus (p = .02); recurrent acute rejection episodes (p < .0005); lymphocytic bronchiolitis (p = .0001); and tissue eosinophilia, regardless of the rejection grade (p < .0001).

Conclusions: Increased expression of TGF-beta is a risk factor for the development of OB. Other risk factors are recurrent acute rejection, lymphocytic bronchiolitis, tissue eosinophilia, and two mismatches at the HLA-A locus. This suggests that the pathogenesis of progressive small airway fibrosis characteristic of OB may be inflammatory damage, followed by an aberrant repair process due to excessive TGF-beta production following allograft injury. Hence, modulation of TGF-beta levels or function by antagonists may represent an important approach to control OB.

MeSH terms

  • Adult
  • Bronchiolitis Obliterans / etiology
  • Bronchiolitis Obliterans / metabolism*
  • Bronchiolitis Obliterans / pathology
  • HLA Antigens / analysis
  • Histocompatibility
  • Humans
  • Immunohistochemistry
  • Lung / chemistry
  • Lung / pathology
  • Lung Transplantation / adverse effects*
  • Middle Aged
  • Pulmonary Fibrosis / etiology
  • Pulmonary Fibrosis / metabolism
  • Pulmonary Fibrosis / pathology
  • Retrospective Studies
  • Risk Factors
  • Transforming Growth Factor beta / analysis*


  • HLA Antigens
  • Transforming Growth Factor beta