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Copyright ©ERS Journals Ltd 2005
Is it bronchiolitis obliterans syndrome or is it chronic rejection: a reappraisal?
1 Depts of Respiratory Diseases and Lung Transplantation Unit, and 2 Dept of Thoracic Surgery, University Hospital Gasthuisberg 49, Herestraat, B-3000 Leuven, Belgium
CORRESPONDENCE: G. M. Verleden, University Hospital Gasthuisberg, Dept of Respiratory Diseases and Lung Transplantation Unit 49, Herestraat, B-3000 Leuven, Belgium. Fax: 32 16346803. E-mail: geert.verleden@uz.kuleuven.ac.be
Keywords: Bronchiolitis obliterans syndrome, chronic rejection, lung transplantation
Received: May 13, 2004
Accepted October 2, 2004
Chronic rejection (obliterative bronchiolitis) is the single most important cause of chronic allograft dysfunction and late mortality after lung transplantation. As this condition is difficult to prove using biopsy specimens, a clinical term, bronchiolitis obliterans syndrome (BOS) has been in use for >10 yrs to describe the progressive decrease of pulmonary function. However, before diagnosing a patient as having BOS, based on a sustained and progressive decrease in forced expiratory volume in one second and/or forced mid-expiratory flow between 25–75% of forced vital capacity, different confounding factors have to be eliminated.
Treatment of BOS mainly consists of an increase or a change in the immunosuppressive drug regimen, which may lead to more pronounced infectious complications. Recently, two new options have become available to treat patients with BOS, treatment of gastro-oesophageal reflux and azithromycin.
In the present paper, the authors give an overview of the current data on these two modalities, which may lead to a restoration of the pulmonary function in some of the patients, illustrating once more the fact that bronchitis obliterans syndrome is not always a manifestation of chronic rejection.
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