BACKGROUND: Bronchiolitis obliterans syndrome is the major complication in long-term survival of patients with lung transplants. Bronchiolitis obliterans syndrome is thought to represent a form of chronic allograft rejection and is associated with obstructive airways disease. Viral infections or other exogenous factors may trigger this condition. METHODS: Because respiratory viral infections show seasonal clustering we studied seasonal onset of bronchiolitis obliterans syndrome in 157 lung and heart-lung transplant recipients. Individual baseline values of forced expiratory volume in 1 second were evaluated according to the International Society for Heart and Lung Transplantation criteria. For bronchiolitis obliterans syndrome classification, values of forced expiratory volume in 1 second were determined by the average of two measurements made at least 1 month apart. Onset of bronchiolitis obliterans syndrome was defined as the date of the initial pulmonary function test showing a persistent decline of forced expiratory volume in 1 second. Other factors causing obstructive airways disease were excluded. RESULTS: Forty-nine patients (31%) showed development of bronchiolitis obliterans syndrome (n = 10 stage I, n = 13 stage II, n = 26 stage III) with onset of bronchiolitis obliterans syndrome 507 +/- 372 days (mean +/- standard deviation) after transplantation. Baseline value of forced expiratory volume in 1 second was reached at 270 +/- 231 days. Between January and March of each year onset of bronchiolitis obliterans syndrome developed in 23 patients (47%). In the second (April to June) and third (July to September) quarters a persistent decline of pulmonary function test results developed in 13 (27%) and 12 (24%) patients, respectively, whereas only 1 patient (2%) showed deterioration between October and December (p < 0.001). CONCLUSIONS: Seasonal clustering of onset of bronchiolitis obliterans syndrome might thus indicate underlying unknown infectious triggers.
BACKGROUND:Bronchiolitis obliterans syndrome is the major complication in long-term survival of patients with lung transplants. Bronchiolitis obliterans syndrome is thought to represent a form of chronic allograft rejection and is associated with obstructive airways disease. Viral infections or other exogenous factors may trigger this condition. METHODS: Because respiratory viral infections show seasonal clustering we studied seasonal onset of bronchiolitis obliterans syndrome in 157 lung and heart-lung transplant recipients. Individual baseline values of forced expiratory volume in 1 second were evaluated according to the International Society for Heart and Lung Transplantation criteria. For bronchiolitis obliterans syndrome classification, values of forced expiratory volume in 1 second were determined by the average of two measurements made at least 1 month apart. Onset of bronchiolitis obliterans syndrome was defined as the date of the initial pulmonary function test showing a persistent decline of forced expiratory volume in 1 second. Other factors causing obstructive airways disease were excluded. RESULTS: Forty-nine patients (31%) showed development of bronchiolitis obliterans syndrome (n = 10 stage I, n = 13 stage II, n = 26 stage III) with onset of bronchiolitis obliterans syndrome 507 +/- 372 days (mean +/- standard deviation) after transplantation. Baseline value of forced expiratory volume in 1 second was reached at 270 +/- 231 days. Between January and March of each year onset of bronchiolitis obliterans syndrome developed in 23 patients (47%). In the second (April to June) and third (July to September) quarters a persistent decline of pulmonary function test results developed in 13 (27%) and 12 (24%) patients, respectively, whereas only 1 patient (2%) showed deterioration between October and December (p < 0.001). CONCLUSIONS: Seasonal clustering of onset of bronchiolitis obliterans syndrome might thus indicate underlying unknown infectious triggers.
Authors: Damien J LaPar; Alykhan S Nagji; Castigliano M Bhamidipati; Benjamin D Kozower; Christine L Lau; Gorav Ailawadi; David R Jones Journal: Eur J Cardiothorac Surg Date: 2010-12-18 Impact factor: 4.191
Authors: Peter M Hopkins; Marshall L Plit; Ian W Carter; Prashant N Chhajed; Monique A Malouf; Allan R Glanville Journal: J Heart Lung Transplant Date: 2003-02 Impact factor: 10.247