Hee Suk Jung1, Jin Gu Lee2, Woo Sik Yu2, Chang Young Lee2, Seok Jin Haam2, Hyo Chae Paik3. 1. Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Pocheon, Gyeonggi-do, Republic of Korea. 2. Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea. 3. Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea hcpaik@yuhs.ac.
Abstract
OBJECTIVES: Bronchiolitis obliterans syndrome (BOS) is a serious late complication following allogeneic haematopoietic stem cell transplantation (allo-HSCT) and is associated with chronic graft-versus-host disease. However, the outcome of medical treatment for BOS, mainly immunosuppressive therapy, is disappointing. This study evaluated the early outcomes of lung transplantation (LTx) as a treatment option for severe BOS. METHODS: Between January 2010 and December 2014, we retrospectively reviewed the medical records and postoperative outcomes of 9 patients who underwent LTx for BOS after allo-HSCT at a single institution. RESULTS: The median age of patients at the time of LTx was 21 years, and the median interval from the diagnosis of BOS to LTx was 17.1 months. At the time of LTx, 5 patients were receiving oxygen therapy via nasal prongs, whereas the remaining 4 were receiving mechanical ventilation supports, 2 of whom requiring extracorporeal lung support. All patients underwent bilateral lung transplantation. During a median follow-up of 17 months after LTx, 2 patients died: one of intra-cranial haemorrhage and pneumonia during hospitalization and another patient of pneumonia and septic shock after discharge. Although the follow-up was short, the remaining 7 patients are currently healthy and active except one who developed BOS 45.3 months after LTx; he is on the waiting list for retransplantation. One patient experienced acute rejection that resolved after steroid pulse therapy. There was no relapse of the haematological disease after LTx. CONCLUSIONS: LTx could be a reasonable therapeutic option in selected patients with refractory BOS not responsive to conventional therapy.
OBJECTIVES:Bronchiolitis obliterans syndrome (BOS) is a serious late complication following allogeneic haematopoietic stem cell transplantation (allo-HSCT) and is associated with chronic graft-versus-host disease. However, the outcome of medical treatment for BOS, mainly immunosuppressive therapy, is disappointing. This study evaluated the early outcomes of lung transplantation (LTx) as a treatment option for severe BOS. METHODS: Between January 2010 and December 2014, we retrospectively reviewed the medical records and postoperative outcomes of 9 patients who underwent LTx for BOS after allo-HSCT at a single institution. RESULTS: The median age of patients at the time of LTx was 21 years, and the median interval from the diagnosis of BOS to LTx was 17.1 months. At the time of LTx, 5 patients were receiving oxygen therapy via nasal prongs, whereas the remaining 4 were receiving mechanical ventilation supports, 2 of whom requiring extracorporeal lung support. All patients underwent bilateral lung transplantation. During a median follow-up of 17 months after LTx, 2 patients died: one of intra-cranial haemorrhage and pneumonia during hospitalization and another patient of pneumonia and septic shock after discharge. Although the follow-up was short, the remaining 7 patients are currently healthy and active except one who developed BOS 45.3 months after LTx; he is on the waiting list for retransplantation. One patient experienced acute rejection that resolved after steroid pulse therapy. There was no relapse of the haematological disease after LTx. CONCLUSIONS:LTx could be a reasonable therapeutic option in selected patients with refractory BOS not responsive to conventional therapy.
Authors: Matteo Di Nardo; Ali H Ahmad; Pietro Merli; Matthew S Zinter; Leslie E Lehman; Courtney M Rowan; Marie E Steiner; Sangeeta Hingorani; Joseph R Angelo; Hisham Abdel-Azim; Sajad J Khazal; Basirat Shoberu; Jennifer McArthur; Rajinder Bajwa; Saad Ghafoor; Samir H Shah; Hitesh Sandhu; Karen Moody; Brandon D Brown; Maria E Mireles; Diana Steppan; Taylor Olson; Lakshmi Raman; Brian Bridges; Christine N Duncan; Sung Won Choi; Rita Swinford; Matt Paden; James D Fortenberry; Giles Peek; Pierre Tissieres; Daniele De Luca; Franco Locatelli; Selim Corbacioglu; Martin Kneyber; Alessio Franceschini; Simon Nadel; Matthias Kumpf; Alessandra Loreti; Roelie Wösten-Van Asperen; Orsola Gawronski; Joe Brierley; Graeme MacLaren; Kris M Mahadeo Journal: Lancet Child Adolesc Health Date: 2021-12-09