Lung rejectionAcute and chronic onset of bronchiolitis obliterans syndrome (BOS): are they different entities?
Section snippets
Patients and methods
The study population consisted of 230 consecutive patients having undergone lung transplantation between April 1984 and December 1995, and who survived at least 6 months after transplantation, and thus at risk for the development of BOS. Of these, 26 patients were excluded because either a baseline or BOS onset could not be established from the available data.5 Thus, the study cohort consisted of 204 patients that included 143 heart–lung (HLTx), 9 double-lung (DLTx) and 52 single-lung (SLTx)
Study cohort
The 204 patients were between 11 and 69 years of age at the time of transplantation, with a mean age of 38 (SD 13) years. There were 110 (54%) males and 94 (46%) females. The study cohort consisted of 143 heart–lung (HLTx), 9 double-lung (DLTx) and 52 single-lung (SLTx) transplants. The main indications for HLTx were cystic fibrosis (n = 53), Eisenmenger syndrome (n = 27), primary pulmonary hypertension (n = 17) and bronchiectasis (n = 13). The main indications for SLTx were emphysema (n = 36)
Discussion
The impact of OB in lung transplant recipients is very significant and has shown a prevalence of around 65% at 5 years.7, 8, 9 An understanding of the natural history of the disease can give important insights into its pathogenesis and suggest strategies for treatment development.
The adoption of FEV1 as a physiologic surrogate marker for OB has proved successful in describing the pattern of functional decline and the identification of the main risk factors for BOS. In addition, it is a
References (11)
- et al.
Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart–lung transplantation
Chest
(1984) - et al.
Transforming growth factor beta (TGF-β) and obliterative bronchiolitis following pulmonary transplantation
J Heart Lung Transplant
(1999) - et al.
Tests of airway function in detecting and monitoring treatment of obliterative bronchiolitis after lung transplantation
J Heart Lung Transplant
(2000) - et al.
Does histologic acute rejection in lung allografts predict the development of bronchiolitis obliterans?
Transplantation
(1991) - et al.
Immunologic mechanisms underlying bronchiolitis obliterans
Cur Opin Org Transplant
(2000)
Cited by (71)
Inferior outcomes in lung transplant recipients with serum Pseudomonas aeruginosa specific cloaking antibodies
2021, Journal of Heart and Lung TransplantationPredictors of survival in restrictive chronic lung allograft dysfunction after lung transplantation
2016, Journal of Heart and Lung TransplantationCitation Excerpt :This proportion seems relatively low compared with the proportions described by the Toronto group, as they described an acute exacerbation (possible trigger) during follow-up of every RAS case analyzed.12 On the other hand, this finding seems to be in line with the 33% described previously in BOS.19 Our study has some shortcomings, such as the relatively small number of patients, the heterogeneity of diagnostic criteria, and the large proportion of patients undergoing lung re-transplantation.
Observational study of lung transplant recipients surviving 20 years
2016, Respiratory MedicineHome spirometry as early detector of azithromycin refractory bronchiolitis obliterans syndrome in lung transplant recipients
2014, Respiratory MedicineCitation Excerpt :Bronchiolitis obliterans syndrome (BOS) remains the leading cause of death beyond the first year after transplantation [1], affecting almost half of all patients within 5 years. BOS is characterized by its unpredictable and variable clinical course, ranging from an insidious onset with gradual loss of pulmonary function over months to years, to an abrupt and severe decline in pulmonary function within a matter of weeks [2–4]. Whilst obliterative bronchiolitis is the presumed histopathological correlate, it is not consistently detectable by transbronchial biopsy and spirometry is routinely used as the agreed surrogate marker to diagnose and stage BOS [5].
A new classification system for chronic lung allograft dysfunction
2014, Journal of Heart and Lung TransplantationTime-dependent changes in the risk of death in pure bronchiolitis obliterans syndrome (BOS)
2013, Journal of Heart and Lung Transplantation