Chest
Original ResearchPathologic Correlates of Bronchiolitis Obliterans Syndrome in Pulmonary Retransplant Recipients
Section snippets
Materials and Methods
This study is a retrospective observational study done at Duke University Medical Center. After institutional research board approval, all adult patients who underwent lung or heart-lung transplantation at Duke University Medical Center between 1992 and 2002 were identified. A total of 460 such patients were found, 19 of whom were lung or heart-lung retransplant recipients (4%). Of these 19 patients, 7 underwent retransplantation for primary graft failure and 12 patients were identified who
Demographics and Outcomes Data
Characteristics of patients retransplanted for BOS are illustrated in Table 1. Five patients were men, and seven patients were women. The reasons for initial transplantation were emphysema (n = 3), cystic fibrosis (n = 4), idiopathic pulmonary fibrosis (n = 4), and aluminum pneumoconiosis (n = 1). At the time of retransplantation, 10 patients had severe clinical BOS (grade 3) and 2 patients had moderate BOS (grade 2). The median time to BOS was 517 days (intraquartile range [IQR] 396 to 819.8
Discussion
In summary, our report reviews a single-center experience with pulmonary retransplantation for BOS and demonstrates the extent to which BOS correlates with pathologic BO. All patients had evidence of significant BO in their explanted allografts, but a broad range of epithelial, fibrotic, and inflammatory changes were seen and several unexpected pathologic findings were identified.
In order to perform a detailed histopathologic analysis of explanted lung allografts of patients undergoing
References (40)
- et al.
The registry of the international society for heart and lung transplantation: twentieth official adult lung and heart-lung transplant report–2003
J Heart Lung Transplant
(2003) - et al.
Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria
J Heart Lung Transplant
(2002) - et al.
Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart-lung transplantation
Chest
(1984) - et al.
Pathologic pulmonary alterations in long-term human heart-lung transplantation
Hum Pathol
(1985) - et al.
The pathology of combined heart-lung transplantation: an autopsy study
Hum Pathol
(1988) - et al.
Chronic rejection in single-lung transplantation manifested by obliterative bronchiolitis
J Thorac Cardiovasc Surg
(1990) - et al.
Hemorrhagic infarction of hilar lymph nodes associated with combined heart-lung transplantation
J Thorac Cardiovasc Surg
(1990) - et al.
Cytomegalovirus pneumonitis in heart-lung transplant recipients: histopathology and clinicopathologic considerations
Hum Pathol
(1990) - et al.
The two forms of bronchiolitis obliterans in heart-lung transplant recipients
Hum Pathol
(1991) - et al.
Postmortem findings in lung transplant recipients: lessons still to be learned [abstract]
J Heart Lung Transplant
(2002)
Pulmonary retransplantation
Semin Thorac Cardiovasc Surg
Pulmonary retransplantation: predictors of graft function and survival in 230 patients
Ann Thorac Surg
Association of humoral immunity and bronchiolitis obliterans syndrome
Am J Transplant
Gastroesophageal reflux as a reversible cause of allograft dysfunction after lung transplantation
Chest
Lung transplantation exacerbates gastroesophageal reflux disease
Chest
Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease
Ann Thorac Surg
Lung homotransplantation in man
JAMA
Bronchiolitis obliterans in heart-lung transplantation patients: radiologic findings in 11 patients
AJR Am J Roentgenol
Bronchiolitis obliterans syndrome in lung transplant recipients: correlation of computed tomography findings with bronchiolitis obliterans syndrome stage
J Thorac Imaging
Bronchiolitis obliterans after lung transplantation: findings at chest radiography and high-resolution CT. The Toronto lung transplant group
Radiology
Cited by (69)
Pathology of lung transplantation
2022, Practical Pulmonary Pathology: A Diagnostic ApproachInterleukin 6 trans-signaling is a critical driver of lung allograft fibrosis
2021, American Journal of TransplantationSpectrum of findings on ventilation‒perfusion lung scintigraphy after lung transplantation and association with outcomes
2021, Journal of Heart and Lung TransplantationChronic lung allograft dysfunction: Definition and update of restrictive allograft syndrome―A consensus report from the Pulmonary Council of the ISHLT
2019, Journal of Heart and Lung TransplantationCommon Causes of Diffuse Alveolar Damage in the Pulmonary Allograft
2018, Practical Pulmonary Pathology: A Diagnostic Approach A Volume in the Pattern Recognition Series
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
This work was performed at Duke University Medical Center.