BACKGROUND: Obliterative bronchiolitis (OB) is the main chronic complication after heart-lung (HLTx) and lung transplantation (LTx), limiting the long-term success of both transplant procedures. METHODS: Since 1981, 135 HLTxs and 61 isolated LTxs were performed in 184 patients at Stanford University. RESULTS: The overall prevalence of OB in patients surviving longer than 3 months postoperatively was 64% after HLTx and 68% after LTx. The actuarial freedom from OB was 72%, 51%, 44%, and 29% at 1, 2, 3, and 5 years, respectively, after HLTx and LTx. An analysis of potential risk factors revealed that the frequency and severity of acute rejection episodes (p < 0.001) and the appearance of lymphocytic bronchiolitis on biopsy (p < 0.05) were significantly associated with the development of OB. With regard to diagnosis of OB, pulmonary function tests show early reductions of the forced expiratory flow between 25% and 75% of the forced vital capacity with subsequent decreases in the forced expiratory volume in 1 second. The sensitivity of transbronchial biopsies has increased to 71% since 1993. Current treatment consists of augmented immunosuppression. Concurrent acute rejection episodes or active OB on biopsy have been treated aggressively with high-dose steroid pulses. Analysis of data from 73 patients with OB after HLTx and LTx revealed actuarial 1-, 3-, 5-, and 10-year survival of 89%, 71%, 44%, and 17% versus 86%, 77%, 63% and 56% in patients without OB (p < 0.05 by log-rank analysis). The main complication and cause of death in patients with OB was superimposed respiratory tract infection, which was treated aggressively. CONCLUSIONS: Early diagnosis of OB using pulmonary function tests or transbronchial biopsy is possible and important, because immediate treatment initiation has led to acceptable survival rates, with nearly 50% of affected patients still alive 5 years after transplantation. Current experimental research on OB suggests that immune injury is the main pathogenetic event of airway obliteration in animal models; rapamycin and leflunomide are new immunosuppressive agents that may have the potential to prevent and treat airway obliteration.
BACKGROUND:Obliterative bronchiolitis (OB) is the main chronic complication after heart-lung (HLTx) and lung transplantation (LTx), limiting the long-term success of both transplant procedures. METHODS: Since 1981, 135 HLTxs and 61 isolated LTxs were performed in 184 patients at Stanford University. RESULTS: The overall prevalence of OB in patients surviving longer than 3 months postoperatively was 64% after HLTx and 68% after LTx. The actuarial freedom from OB was 72%, 51%, 44%, and 29% at 1, 2, 3, and 5 years, respectively, after HLTx and LTx. An analysis of potential risk factors revealed that the frequency and severity of acute rejection episodes (p < 0.001) and the appearance of lymphocytic bronchiolitis on biopsy (p < 0.05) were significantly associated with the development of OB. With regard to diagnosis of OB, pulmonary function tests show early reductions of the forced expiratory flow between 25% and 75% of the forced vital capacity with subsequent decreases in the forced expiratory volume in 1 second. The sensitivity of transbronchial biopsies has increased to 71% since 1993. Current treatment consists of augmented immunosuppression. Concurrent acute rejection episodes or active OB on biopsy have been treated aggressively with high-dose steroid pulses. Analysis of data from 73 patients with OB after HLTx and LTx revealed actuarial 1-, 3-, 5-, and 10-year survival of 89%, 71%, 44%, and 17% versus 86%, 77%, 63% and 56% in patients without OB (p < 0.05 by log-rank analysis). The main complication and cause of death in patients with OB was superimposed respiratory tract infection, which was treated aggressively. CONCLUSIONS: Early diagnosis of OB using pulmonary function tests or transbronchial biopsy is possible and important, because immediate treatment initiation has led to acceptable survival rates, with nearly 50% of affected patients still alive 5 years after transplantation. Current experimental research on OB suggests that immune injury is the main pathogenetic event of airway obliteration in animal models; rapamycin and leflunomide are new immunosuppressive agents that may have the potential to prevent and treat airway obliteration.
Authors: C Ashley Finlen Copeland; Laurie D Snyder; David W Zaas; W Jackson Turbyfill; W Austin Davis; Scott M Palmer Journal: Am J Respir Crit Care Med Date: 2010-05-27 Impact factor: 21.405
Authors: S S Weigt; R M Elashoff; C Huang; A Ardehali; A L Gregson; B Kubak; M C Fishbein; R Saggar; M P Keane; R Saggar; J P Lynch; D A Zisman; D J Ross; J A Belperio Journal: Am J Transplant Date: 2009-05-13 Impact factor: 8.086
Authors: Hsuanwen C Huang; S Samuel Weigt; Ariss Derhovanessian; Vyacheslav Palchevskiy; Abbas Ardehali; Rajan Saggar; Rajeev Saggar; Bernard Kubak; Aric Gregson; David J Ross; Joseph P Lynch; Robert Elashoff; John A Belperio Journal: J Heart Lung Transplant Date: 2011-04-08 Impact factor: 10.247
Authors: Damien J LaPar; Marie D Burdick; Abbas Emaminia; David A Harris; Brett A Strieter; Ling Liu; Mark Robbins; Irving L Kron; Robert M Strieter; Christine L Lau Journal: Ann Thorac Surg Date: 2011-08 Impact factor: 4.330
Authors: Peter H Hagedorn; Christopher M Burton; Jørn Carlsen; Daniel Steinbrüchel; Claus B Andersen; Eli Sahar; Eytan Domany; Irun R Cohen; Henrik Flyvbjerg; Martin Iversen Journal: Immunology Date: 2010-02-26 Impact factor: 7.397
Authors: S Samuel Weigt; Ariss DerHovanessian; W Dean Wallace; Joseph P Lynch; John A Belperio Journal: Semin Respir Crit Care Med Date: 2013-07-02 Impact factor: 3.119
Authors: Sara A Hennessy; Tjasa Hranjec; Brian R Swenson; Benjamin D Kozower; David R Jones; Gorav Ailawadi; Irving L Kron; Christine L Lau Journal: Ann Thorac Surg Date: 2010-05 Impact factor: 4.330