Editor's highlightRestrictive allograft syndrome (RAS): A novel form of chronic lung allograft dysfunction
Section snippets
Materials and methods
This study was approved by the Research Ethics Board of University Health Network.
Pulmonary function tests
Among 468 patients, CLAD developed in 156; of these, 47 (30%) showed the phenotype of RAS by the end of observation and the remaining 109 patients were categorized into BOS (Figure 1, Figure 3A) based on changes in TLC. Patient characteristics among the groups of RAS, BOS, and no CLAD were similar except for the cytomegalovirus status, which showed initial statistic difference across groups and a trend toward a higher ratio of donor-positive recipient-negative mismatch in the RAS group in a
Discussion
We found that lung transplant patients with CLAD with decreased FEV1 are not a single homogeneous group but can be categorized into 2 distinct sub-sets. One group of patients with CLAD that we named restrictive allograft syndrome (RAS) exhibits restrictive functional changes with fibrotic processes in peripheral lung tissue, rather than the classically described radiologic or pathologic findings of small airway obliteration seen in BOS.
Increasing evidence suggests that CLAD is a
Disclosure statement
Part of the data presented in this article were presented at the Thirtieth Annual Scientific Meeting of the International Society for Heart and Lung Transplantation in Chicago, April 21-24, 2010.
M.S. was a recipient of Canadian Cystic Fibrosis Foundation Post-doctoral Fellowship (2007–2009).
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
References (22)
- et al.
The Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Lung and Heart-Lung Transplantation Report-2009
J Heart Lung Transplant
(2009) - et al.
Role of autoimmunity in organ allograft rejection: a focus on immunity to type V collagen in the pathogenesis of lung transplant rejection
Am J Physiol Lung Cell Mol Physiol
(2004) - et al.
Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria
J Heart Lung Transplant
(2002) - et al.
Bronchiolitis obliterans syndrome: alloimmune-dependent and -independent injury with aberrant tissue remodeling
Semin Thorac Cardiovasc Surg
(2008) - et al.
Pathologic correlates of bronchiolitis obliterans syndrome in pulmonary retransplant recipients
Chest
(2006) - et al.
Lung transplantation: opportunities for research and clinical advancement
Am J Respir Crit Care Med
(2005) - et al.
A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy
Eur Respir J
(2008) - et al.
Bronchiolitis obliterans and lung transplantation: evidence for an infectious etiology
Semin Respir Infect
(2002) - et al.
Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease
Ann Thorac Surg
(2004) - et al.
Acute and chronic onset of bronchiolitis obliterans syndrome (BOS): are they different entities?
J Heart Lung Transplant
(2002)