Chest
Clinical Investigations: Lung TransplantationBronchiolitis Obliterans in Single-Lung Transplant Recipients
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
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Cited by (53)
Comparison of extracorporeal photopheresis and alemtuzumab for the treatment of chronic lung allograft dysfunction
2018, Journal of Heart and Lung TransplantationCitation Excerpt :This difference in baseline rate of FEV1 decline in the NT group likely reflects a less severe phenotype of CLAD with a differing natural history that cannot be accounted for by IPWRA adjustment alone. Prior studies of the natural history of CLAD suggest an indolent phenotype and a more rapidly progressive phenotype, with the rate of decline in FEV1 preceding CLAD diagnosis as a clear risk factor for a poorer prognosis.17–19 The patients in our study who received ECP or AL had a more rapid rate of decline and thus represented a poorer prognostic group, which likely impacted the decision to institute advanced therapies.
Azithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome
2010, Journal of Heart and Lung TransplantationCitation Excerpt :The association between FEV1 at time of BOS stage 1 and increased risk of death was not unexpected; however, the natural course of FEV1 progression after onset of BOS is believed to vary among patients and over time. Accordingly, results of future studies should account for this variable and analyzing factors that influence the relationship between FEV1 at BOS Stage 1 and survival would be worthy of future analysis.20,21 The mechanisms responsible for the benefit of azithromycin were not addressed in this study and remain unclear.
Prognostic value of the 6 min walk test in bronchiolitis obliterans syndrome
2009, Respiratory MedicineCitation Excerpt :There is no proven effective therapy for BOS and management is usually directed towards its prevention, as well as augmenting immunosuppression and minimizing complications, such as infections.2 BOS can have a highly variable course with different clinical patterns of presentation and progression having been reported.6–9 Patients have also been categorized based on bronchoalveolar lavage neutrophilia.10–13
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2008, Pediatric Respiratory MedicineBronchiolitis Obliterans
2008, Pediatric Respiratory MedicineRecovery of chronic renal impairment with sirolimus after lung transplantation
2004, Annals of Thoracic Surgery
revision accepted August 17.