The pulmonary hypertension (PAH) in chronic obstructive lung disease include therapy of the respiratory disease i.e. bronchodilator, kinesitherapy. Long-term oxygen therapy (more than 15 h/day) reverse the course of PAH and increase survey. Long-term efficiency of vasodilators is not well demonstrated. Primary PAH could benefit from vasodilators, especially waiting lung or heart-lung transplantation. Patients with PAH secondary to respiratory insufficiency could also be successfully transplanted. In post embolic PAH, antithrombotic agents are useful. Thrombectomy or transplantation are sometimes proposed.
Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24hi CD38hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hi CD38hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9+ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24hi CD38hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.
