Literature review
Risk factors for bronchiolitis obliterans: a systematic review of recent publications

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Abstract

Background: Obliterative bronchiolitis remains the major limitation to long-term survival after lung transplantation. A thorough understanding of the factors that confer high risk of developing obliterative bronchiolitis or its physiologic surrogate bronchiolitis obliterans syndrome is important to help define therapeutic strategies.

Methods: We performed a systematic review of studies published since the beginning of 1990. The review excluded non-human studies, publications before 1990, small (less than 25 patients) studies that were predominantly concerned with investigating the pathogenesis of obliterative bronchiolitis, studies solely concerned with diagnosis or treatment of obliterative bronchiolitis, and overlapping studies from the same center. Onset of bronchiolitis obliterans syndrome or obliterative bronchiolitis was the outcome of interest.

Results: Acute rejection plays an important role in obliterative bronchiolitis and bronchiolitis obliterans syndrome onset, and late rejection is a significant risk factor. Lymphocytic bronchitis/bronchiolitis is also a risk factor, with some evidence that late onset is associated with greater risk. The effects of cytomegalovirus, other infectious organisms, and human leukocyte antigen matching are less clear and require further confirmation. There is little evidence that recipient and donor characteristics play a major role.

Conclusions: This systematic review supports the view that obliterative bronchiolitis arises from alloimmunologic injury marked by clinically apparent acute rejection episodes and that inflammatory conditions, including viral infections or ischemic injury, may also play a role. Implications for therapy are discussed.

Section snippets

Methods

We performed a manual search on Medline to identify studies published since January 1990. In addition, we examined reviews and reference lists from published studies. No attempt was made to extract unpublished data. All studies that included the terms “obliterative bronchiolitis” or “bronchiolitis obliterans syndrome” and the term “lung Transpl∗” were considered and abstracts were read. Further investigation was confined to studies on risk factors so that the following were excluded: non-human

Studies

The initial search identified 588 publications. Exclusion of non-human studies; those published before 1990; and studies solely concerned with mechanism, diagnosis, or treatment of OB left 75 articles that were copied and read in full. References of these articles are available from the authors (LDS). From these papers, 50 were either superceded by later articles, were not related to risk factors, or contained insufficient information on any risk factors to be included in the review. The

Discussion

This review reveals the current evidence for risk factors for BOS and OB in the published literature. Since the adoption of the internationally accepted physiologic definition of BOS,3 almost all studies have focused on risk factors for this surrogate measure of OB. Earlier studies concentrated on histologically defined OB, but such studies were small and less robust. Thus, it is not possible to reliably differentiate between risk factors for BOS and those for OB from published work.

The

References (28)

  • J.D. Cooper et al.

    A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. International Society for Heart and Lung Transplantation

    J Heart Lung Transplant

    (1993)
  • R.E. Girgis et al.

    Risk factors for the development of obliterative bronchiolitis after lung transplantation

    J Heart Lung Transplant

    (1996)
  • S. Sundaresan et al.

    HLA-A locus mismatches and development of antibodies to HLA after lung transplantation correlate with the development of bronchiolitis obliterans syndrome

    Transplantation

    (1998)
  • K. Bando et al.

    Obliterative bronchiolitis after lung and heart-lung transplantation. An analysis of risk factors and management

    J Thorac Cardiovasc Surg

    (1995)
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