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Clinical InvestigationsTRANSPLANTATIONBronchiolitis Obliterans Syndrome and Additional Costs of Lung Transplantation
Section snippets
Materials and Methods
In 1991, a technology assessment study of the Dutch Lung Transplant Program at the University Hospital of Groningen (UHG) wasinitiated by the Dutch National Health Insurance Board. From November1990 until April 1995, data were gathered on all patients entering the, Dutch Lung Transplant Program. The aim of the technology assessment wasto provide information on costs, clinical effectiveness, quality oflife, demand for lung transplantation, and supply ofdonors.6 In the present study, data
Results
Of the 57 patients who underwent transplantation between November1990 and April 1995, 53 patients survived > 60 days aftertransplantation and entered the outpatient follow-up phase. Sixteenpatients developed BOS during the study period. Patient characteristicsare specified in Table 1.
Table 2 presents the average costs of the outpatient follow-up phase expressedin Dutch guilders (Dfl) per patient per week for each category. Thetotal costs per week of follow-up were statistically
Discussion
More than 15 years ago, Burke et al11 reported asyndrome of irreversible severe air flow obstruction and typicalhistologic features of obliterative bronchiolitis in several heart-lungrecipients. Today, BOS remains a major impediment to long-term successafter heart or lung transplantation. In the present study, for thefirst time, it was demonstrated that BOS is associated withconsiderable extra costs. This may not be surprising, as BOS isassociated with increased morbidity, mainly by
References (21)
- et al.
Cost-effectiveness of lung transplantation in The Netherlands: a scenario analysis
Chest
(1998) - et al.
The Registry of the International Society for Heart and Lung Transplantation: sixteenth official report–1999
J Heart Lung Transplant
(1999) - et al.
The friction cost method for measuring indirect costs of disease
J Health Econ
(1995) - et al.
Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart-lung transplantation
Chest
(1984) - et al.
The cost-effectiveness of lung transplantation: a pilot study, University of Washington Medical Center Lung Transplant Study Group
Chest
(1995) - et al.
Airway obstruction and bronchiolitis obliterans after lung transplantation
Clin Chest Med
(1993) - et al.
Cytolytic therapy for the bronchiolitis obliterans syndrome complicating lung trans- plantation
Chest
(1996) - et al.
FK506 “rescue” immunosuppression for obliterative bronchiolitis after lung transplantation
Chest
(1997) - et al.
Prevalence and outcome of bronchiolitis obliterans syndrome after lung transplantation. Washington University Lung Transplant Group
Ann Thorac Surg
(1995) - et al.
Stanford experience with obliterative bronchiolitis after lung and heart-lung transplantation
Ann Thorac Surg
(1996)
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Self-reactive antibodies associated with bronchiolitis obliterans syndrome subtype of chronic lung allograft dysfunction
2021, Human ImmunologyCitation Excerpt :Bronchiolitis Obliterans Syndrome (BOS) continues to be the most prevalent presentation of CLAD accounting for 60–75% of cases [2]. In addition to being the leading cause of death after lung transplantation, BOS impairs quality of life, causes significant morbidity and increased costs [3]. Only few therapeutic options are now in place for management of BOS and is generally not reversible.
Exploring the meaning of chronic rejection after lung transplantation and its impact on clinical management and caregiving
2010, Journal of Pain and Symptom ManagementCitation Excerpt :This decline in survival is more rapid compared with other solid organ transplant recipients; three- and five-year survival rates are 80% and 74% for heart and 94% and 90% for kidney transplant recipients, respectively.2 The primary threat to survival and quality of life after lung transplantation is the development of chronic rejection, which manifests as bronchiolitis obliterans syndrome (BOS), and affects more than 34%–64% of recipients by Year 5.3–5 BOS is determined based on established criteria:6 evidence of ≥20% decline forced expiratory volume in one second (FEV1) from baseline (personal best) within a three-week interval in the absence of any confounding conditions (i.e., infection, acute cellular rejection, or airway stenosis) to explain the airflow obstruction.
Update in Surgical Therapy for Chronic Obstructive Pulmonary Disease
2007, Clinics in Chest MedicineCitation Excerpt :Furthermore, ISHLT Registry data reveal that most patients live without any activity limitations, and approximately 40% go back to part-time or full-time work, which is remarkable considering the universal presence of severe pretransplant disability [58]. It is important to note, however, that most of these outcome variables, along with health status, decline over time with the development of BOS [74,76]. Lung transplantation is associated with high short- and long-term mortality related to numerous potential complications.
Economics of transplantation: a review of the literature
2006, Transplantation ReviewsBronchiolitis obliterans syndrome: Pathogenesis and management
2004, Seminars in Thoracic and Cardiovascular SurgeryThe impact of traffic air pollution on bronchiolitis obliterans syndrome and mortality after lung transplantation
2011, ThoraxCitation Excerpt :These population-attributable fractions are significant not only in terms of patient suffering but also in terms of healthcare costs. The yearly mean cost after lung transplantation is €46100 for a stable patient and €79100 for a patient with BOS.37 38 In conclusion, the study found that exposure to traffic-related air pollution independently increased the risk of BOS and mortality in lung transplant patients and was associated with lung and systemic inflammation.