Chest
Volume 107, Issue 4, April 1995, Pages 967-972
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Clinical Investigations: Lung Transplantation
Bronchiolitis Obliterans in Single-Lung Transplant Recipients

https://doi.org/10.1378/chest.107.4.967Get rights and content

The presentation and clinical course of bronchiolitis obliterans (BO) in single-lung transplant (SLT) recipients has thus far not been well described. We retrospectively analyzed the serial spirometry of 15 SLT patients with BO. All the patients fulfilled the criteria for BO syndrome, and 11 of the 15 had histologically documented BO. Based on serial FEV1 analysis, we identified three patterns of presentation and progression of BO. The first pattern (n=6) was characterized by a rapid onset and a relentless progressive course; the second pattern (n=5) was characterized by a similar rapid onset and initial rapid decline, but was followed by stabilization in lung function; the third pattern (n=4) was characterized by an insidious onset and course. In all patients, a permanent reduction in the mean forced expiratory flow during the middle half of the forced vital capacity appeared to be an early sensitive index for the development of BO. An appreciation of these different modes of presentation and progression of BO is potentially important in the assessment of prognosis and management of the SLT recipient.

Section snippets

Clinical Data

Over a period of 4 years, we performed 37 adult SLTs. Postoperative immunosuppression consisted of induction immunosuppression in the immediate postoperative period with either OKT3 (5 mg/d), Minnesota anti-lymphocyte globulin, or antithymocyte globulin (ATG) (15 mg/kg/d) for 5 to 7 days. Maintenance immunosuppression therapy consisted of triple-drug therapy with cyclosporin A, azathioprine (1 to 2 mg/kg/d), and prednisone (tapered to a daily dose of 5 to 15 mg/d). Cyclosporin A whole blood

Results

Of the 26 SLT recipients who survived longer than 6 months, 15 have developed BO syndrome. The diseases for which these 15 patients were initially transplanted included the following: pulmonary fibrosis (7); COPD (5); sarcoidosis (1); primary pulmonary hypertension (PPH [1]); and lymphangioleiomyomatosis (1). Patient characteristics are shown in Table 1. Of the 15 patients, 11 have histologically proven BO. Of the histologically proven, 6 were documented with TBB, 2 with open-lung biopsy, and 3

Discussion

By analyzing the serial spirometry of a group of SLT recipients with BO, we have characterized the onset and progression of BO. The patients may present in one of two ways: either suddenly or insidiously. These two patterns of presentation have previously been reported in heart-lung and lung transplant recipients.3, 13, 14 Those patients who presented insidiously continued to progress in this fashion with none of the five patients in this group manifesting increased rates of decrement in lung

References (16)

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revision accepted August 17.

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