HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Scott J. Swanson Michael T. Jaklitsch David J. Sugarbaker Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Swanson, S. J. Articles by Sugarbaker, D. J. Search for Related Content PubMed PubMed Citation Articles by Swanson, S. J. Articles by Sugarbaker, D. J.

J Thorac Cardiovasc Surg 2000;119:27-038
© 2000 Mosby, Inc.

CARDIOTHORACIC TRANSPLANTATION

SURVEILLANCE TRANSBRONCHIAL LUNG BIOPSIES: IMPLICATION FOR SURVIVAL AFTER LUNG TRANSPLANTATION

From the Lung Transplant Program, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass.

Address for reprints: Scott J. Swanson, MD, Division of Thoracic Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E-mail: sjswanson{at}bics.bwh.harvard.edu).

Objectives: We wished to determine whether early rejection after lung transplantation as assessed by surveillance transbronchial biopsy predicts for survival.
Methods: Between 1990 and 1997, 96 consecutive patients had lung transplantation: 89 had a minimum 1-month follow-up. For 71 consecutive patients we have 1-year follow-up and for 69 patients we have the results of the first 3 biopsies. Cytomegalovirus status, bronchiolitis obliterans prevalence, and use of total lymphoid irradiation are noted. Biopsies were done at 1 week and 1, 3, and 6 months. Standard immunosuppression consisted of induction antilymphocyte globulin and high-dose methylprednisolone induction for 1 week and standard maintenance triple therapy. Acute rejection treatment was with pulse methylprednisolone. Bronchiolitis obliterans syndrome was treated with total lymphoid irradiation and a change to tacrolimus and mycophenolate. Blinded grading using International Society for Heart and Lung Transplantation classification was done retrospectively.
Results: Survival at 1 month and 1, 2, and 3 years for the 96-patient cohort with 1-year follow-up was 93%, 74%, 62%, and 56%. Survival was not significantly different for subsets with rejection on any combination of the first 3 biopsies (1/3, 2/3, 3/3) or absence of rejection on the first 3 biopsies. Ninety-one positive biopsy results were graded. Eighteen of 71 patients had one or more moderate or severe rejection episodes without survival difference relative to the others. There was no statistically significant association between acute rejection on the first 3 surveillance biopsy results and bronchiolitis obliterans.
Conclusions: Intensive induction and maintenance immunotherapy with surveillance transbronchial biopsies and aggressive treatment of acute rejection is associated with a survival similar to that of patients without early acute rejection. This regimen appears to uncouple the association between early acute rejection and bronchiolitis obliterans. Further study may elucidate this mechanism.

This article has been cited by other articles:

				A. O. Soubani and J. P. Uberti Bronchiolitis obliterans following haematopoietic stem cell transplantation Eur. Respir. J., May 1, 2007; 29(5): 1007 - 1019. [Abstract] [Full Text] [PDF]

				I. Al-Githmi, N. Batawil, N. Shigemura, M. Hsin, T. W. lee, G.-W. He, and A. Yim Bronchiolitis obliterans following lung transplantation Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 846 - 851. [Abstract] [Full Text] [PDF]

				S. D. Moffatt-Bruce, J. Karamichalis, R. C. Robbins, R. I. Whyte, J. Theodore, and B. A. Reitz Are Heart-Lung Transplant Recipients Protected From Developing Bronchiolitis Obliterans Syndrome? Ann. Thorac. Surg., January 1, 2006; 81(1): 286 - 291. [Abstract] [Full Text] [PDF]

				P. Sandmeier, R. Speich, E. Grebski, P. Vogt, E. W. Russi, W. Weder, and A. Boehler Iron Accumulation in Lung Allografts Is Associated With Acute Rejection But Not With Adverse Outcome Chest, September 1, 2005; 128(3): 1379 - 1384. [Abstract] [Full Text] [PDF]

				R. M. Kotloff, V. N. Ahya, and S. W. Crawford Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation Am. J. Respir. Crit. Care Med., July 1, 2004; 170(1): 22 - 48. [Abstract] [Full Text] [PDF]

				C. Knoop, A. Haverich, and S. Fischer Immunosuppressive therapy after human lung transplantation Eur. Respir. J., January 1, 2004; 23(1): 159 - 171. [Abstract] [Full Text] [PDF]

				A. Boehler and M. Estenne Post-transplant bronchiolitis obliterans Eur. Respir. J., December 1, 2003; 22(6): 1007 - 1018. [Abstract] [Full Text] [PDF]

				M. Estenne and M. I. Hertz Bronchiolitis Obliterans after Human Lung Transplantation Am. J. Respir. Crit. Care Med., August 15, 2002; 166(4): 440 - 444. [Full Text] [PDF]

				C. L. ABOYOUN, M. TAMM, P. N. CHHAJED, P. HOPKINS, M. A. MALOUF, S. RAINER, and A. R. GLANVILLE Diagnostic Value of Follow-up Transbronchial Lung Biopsy after Lung Rejection Am. J. Respir. Crit. Care Med., August 1, 2001; 164(3): 460 - 463. [Abstract] [Full Text] [PDF]