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J Thorac Cardiovasc Surg 1995;110:4-14
© 1995 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

Obliterative bronchiolitis after lung and heart-lung transplantationAn analysis of risk factors and management

Ko Bando, MDa*, Irvin L. Paradis, MDb, Shari Similo, MSc, Hiroaki Konishi, MDa, Kanshi Komatsu, MDa, Thomas G. Zullo, PhDc, Samuel A. Yousem, MDd, John M. Close, PhDc, Adriana Zeevi, PhDd, Rene J. Duquesnoy, PhDd, Jan Manzetti, RN, PhDa, Robert J. Keenan, MDa, John M. Armitage, MDa, Robert L. Hardesty, MDa, Bartley P. Griffith, MDa


Pittsburgh, Pa., Baltimore, Md.

Address for reprints: Ko Bando, MD, Division of Cardiothoracic Surgery, C-700, Presbyterian University Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.

Abstract

With a prevalence of 34% (55/162 at-risk recipients) and a mortality of 25% (14/55 affected recipients), obliterative bronchiolitis is the most significant long-term complication after pulmonary transplantation. Because of its importance, we examined donor-recipient characteristics and antecedent clinical events to identify factors associated with development of obliterative bronchiolitis, which might be eliminated or modified to decrease its prevalence. We also compared treatment outcome between recipients whose diagnosis was made early by surveillance transbronchial lung biopsy before symptoms or decline in pulmonary function were present versus recipients whose diagnosis was made later when symptoms or declines in pulmonary function were present. Postoperative airway ischemia, an episode of moderate or severe acute rejection (grade III/IV), three or more episodes of histologic grade II (or greater) acute rejection, and cytomegalovirus disease were risk factors for development of obliterative bronchiolitis. Recipients with obliterative bronchiolitis detected in the preclinical stage were significantly more likely to be in remission than recipients who had clinical disease at the time of diagnosis: 81% (13/15) versus 33% (13/40); p < 0.05. These results indicate that acute rejection is the most significant risk factor for development of obliterative bronchiolitis and that obliterative bronchiolitis responds to treatment with augmented immunosuppression when it is detected early by surveillance transbronchial biopsy. (J THORACCARDIOVASCSURG1995;110:4-14)




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C. Trello, D. Williams, C. Keller, C Crim, R. Webster, and J. Ohar
Increased gelatinolytic activity in bronchoalveolar lavage fluid in stable lung transplant recipients
Am. J. Respir. Crit. Care Med., December 1, 1997; 156(6): 1978 - 1986.
[Abstract] [Full Text]

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 Ann. Thorac. Surg.Home page
R. I. Whyte, S. J. Rossi, M. S. Mulligan, R. Florn, L. Baker, S. Gupta, F. J. Martinez, and J. P. Lynch III
Mycophenolate Mofetil for Obliterative Bronchiolitis Syndrome After Lung Transplantation
Ann. Thorac. Surg., October 1, 1997; 64(4): 945 - 948.
[Abstract] [Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
T. J. Kroshus, V. R. Kshettry, K. Savik, R. John, M. I. Hertz, and R. M. Bolman III
RISK FACTORS FOR THE DEVELOPMENT OF BRONCHIOLITIS OBLITERANS SYNDROME AFTER LUNG TRANSPLANTATION
J. Thorac. Cardiovasc. Surg., August 1, 1997; 114(2): 195 - 202.
[Abstract] [Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
R. J. Keenan, A. Iacono, J. H. Dauber, A. Zeevi, S. A. Yousem, N. P. Ohori, G. J. Burckart, A. Kawai, G. C. Smaldone, and B. P. Griffith
TREATMENT OF REFRACTORY ACUTE ALLOGRAFT REJECTION WITH AEROSOLIZED CYCLOSPORINE IN LUNG TRANSPLANT RECIPIENTS
J. Thorac. Cardiovasc. Surg., February 1, 1997; 113(2): 335 - 341.
[Abstract] [Full Text]

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 Ann. Thorac. Surg.Home page
H. Reichenspurner, R. E. Girgis, R. C. Robbins, K. L. Yun, M. Nitschke, G. J. Berry, R. E. Morris, J. Theodore, and B. A. Reitz
Stanford Experience With Obliterative Bronchiolitis After Lung and Heart-Lung Transplantation
Ann. Thorac. Surg., November 1, 1996; 62(5): 1467 - 1472.
[Abstract] [Full Text]

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 Ann. Thorac. Surg.Home page
P. Mattsson, A. Zeevi, J. Cai, S. A. Yousem, R. Hoffman, M. Nalesnik, G. J. Burckart, D. Geller, and B. P. Griffith
Effect of Aminoguanidine and Cyclosporine on Lung Allograft Rejection
Ann. Thorac. Surg., July 1, 1996; 62(1): 207 - 212.
[Abstract] [Full Text]


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