Gastroesophageal Reflux in Bronchiolitis Obliterans Syndrome: A New Perspective

King, Benjamin; Iyer, Harisubhash; Leidi, Alessandro; Carby, Martin

doi:10.1016/j.healun.2009.05.040

Cited by 96 publications

(62 citation statements)

References 37 publications

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“…Additional associated risk factors include viral infection [29,31,32,[56][57][58][59][60][61][62][63][64], bacterial infection [65][66][67][68] and fungal infection [69][70][71]. Cytomegalovirus infection engages both the innate and adaptive components of immunity and causes upregulation of HLA class I and class II antigens on epithelial cells [72,73], and stimulates and augments the generation of allogeneic immune responses and proinflammatory cytokines [72,74].…”

Section: Other Risk Factorsmentioning

confidence: 99%

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

et al. 2014

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Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS.A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations.The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of posttransplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS.The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention. Executive summaryMany lung transplant recipients develop delayed allograft dysfunction that has been traditionally referred to as bronchiolitis obliterans syndrome (BOS), which is thought to be caused by inflammation, destruction and fibrosis of small airways in the lung allograft that leads to obliterative bronchiolitis (OB). Because a definitive diagnosis of OB is difficult to make without a surgical lung biopsy, a decrease in the forced expiratory volume in 1 s (FEV1) has been used as a surrogate marker to identify patients who develop a syndrome of significant and persistent loss of lung allograft function with onset three or more months following transplantation. However, it is now recognised that numerous factors apart from OB can lead to a delayed onset, significant decline in lung function, and these causes of delayed onset graft dysfunction must be carefully excluded when a diagnosis of BOS is made. In general, BOS responds poorly to therapeutic interventions but may stabilise, and some patients may have a significant improvement in FEV1 with certain ther...

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Section: Other Risk Factorsmentioning

confidence: 99%

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

et al. 2014

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“…CLAD is postulated to be the end result of multiple alloimmune and nonalloimmune factors that lead to chronic inflammation and lung injury, including primary graft dysfunction (5), alloantibodies (6), acute rejection (7), infections (8)(9)(10) and gastroesophageal reflux (11,12). It is plausible that repeated airway injury from exposure to traffic-associated air pollution could contribute to the development of CLAD.…”

Section: Introduction/backgroundmentioning

confidence: 99%

Air Pollution and the Development of Posttransplant Chronic Lung Allograft Dysfunction

Bhinder

Chen

Sato

et al. 2014

American Journal of Transplantation

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Chronic lung allograft dysfunction (CLAD) is the leading cause of mortality following lung transplantation. We conducted a retrospective cohort study including 397 bilateral lung recipients transplanted in from 1996 to 2009 to determine the association between ambient air pollution, CLAD and mortality. Pollution exposure was assessed using satellite‐based estimates of nitrogen dioxide, distance to major roadway and total length of roadways around a patient's home. Cumulative exposures to ozone and particulate matter were estimated from concentrations measured at fixed‐site stations near patients' homes using inverse distance weighted interpolation. Cox proportional hazards models were used to estimate the associations of CLAD with air pollution exposure, adjusting for various individual and neighborhood characteristics. During the follow‐up, 185 patients developed CLAD (47%) and 101 patients died (25%). Fifty‐four deaths (53%) were due to CLAD. We observed an association between CLAD development and road density within 200 m of a patient's home (HR 1.30 [95% CI 1.07–1.58]). Although based on a subgroup of 14 patients, living within 100 m of a highway was associated with a high risk for developing CLAD (HR 4.91 [95% CI 2.22, 10.87]). These data suggest that exposure to traffic‐related air pollution is associated with development of CLAD among lung transplant recipients.

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“…К дополни тельным факторам риска относятся вирусные [29,31,32,[56][57][58][59][60][61][62][63][64], бактериальные [65][66][67][68] и грибковые инфекции [69][70][71]. Цитомегаловирусной инфекцией поражаются как врожденный, так и адаптивный компоненты иммунитета и стимулируется выработ ка антигенов HLA I и II классов на эпителиальных клетках [72,73], а также стимулируется и усиливает ся аллогенный иммунный ответ и синтез провоспа лительных цитокинов [72,74].…”

Section: рекомендацияunclassified

International practical guidelines on diagnosis, prevention and treatment of bronchiolitis obliterans syndrome

Редакционная¹

2015

Pulʹmonologiâ (Mosk.)

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РезюмеСиндром облитерирующего бронхиолита (СОБ) -серьезное осложнение трансплантации легких, при котором сокращается выживае мость больных. Международным обществом по трансплантации легких и сердца, Американским торакальным и Европейским респира торным обществами созданы Международный комитет экспертов для разработки клинических рекомендаций по ведению пациентов с СОБ. В этих Рекомендациях дано определение СОБ, описаны факторы риска, диагностика, ведение больных и профилактика СОБ. Для разработки Рекомендаций собрана доказательная информация по СОБ с 1980 г. до марта 2013 г. Комитетом экспертов обсуждались доступные научные доказательства. Оценка Рекомендаций проводилась по системе GRADE. Термин СОБ относится к поздней дис функции трансплантата с неуклонным снижением объема форсированного выдоха за 1 ю секунду, необъяснимое другими причинами. В данных Рекомендациях обсуждаются вопросы использования системных глюкокортикостероидов, циклоспорина, такролимуса, азит ромицина и ретрансплантации у больных с предполагаемым и подтвержденным СОБ. В случае диагноза СОБ требуется тщательное исключение других посттрансплантационных осложнений с поздней дисфункцией трансплантата. Выявлено несколько факторов рис ка, тесно связанных с развитием СОБ. В настоящее время отсутствует лечение, при помощи которого можно бы предотвратить или существенно повлиять на СОБ. Для поиска оптимальных методов лечения и эффективных мер профилактики необходимы хорошо спланированные рандомизированные контролируемые исследования, в которых прослеживались бы все значимые для пациента пока затели. Ключевые слова: синдром облитерирующего бронхиолита, трансплантация легких, поздняя дисфункция трансплантата, клинические рекомендации, факторы риска, лечение. DOI: 10.18093/0869 0189 2015 25 4 403 424 International practical guidelines on diagnosis, prevention and treatment of bronchiolitis obliterans syndrome SummaryBronchiolitis obliterans syndrome (BOS) is a serious complication of lung transplantation that decreases the patients' survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society developed the current recommenda tions for better definition of BOS, describing risk factors for developing BOS, diagnosis, management and prevention of BOS. The recommenda tions were based on the evidenced data published from 1980 through to March, 2013 and were evaluated according to the GRADE system. The committee discussed the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and re transplantation in patients with BOS. The diagnosis of BOS should be made after exclusion of other post transplant complications that can cause persistent lung function decline. Currently, there is no therapy able to improve significantly or to prevent BOS development. Further randomised controlled trials are needed to search optimal therapies and preventive measures for BOS.

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Gastroesophageal Reflux in Bronchiolitis Obliterans Syndrome: A New Perspective

Cited by 96 publications

References 37 publications

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

Air Pollution and the Development of Posttransplant Chronic Lung Allograft Dysfunction

International practical guidelines on diagnosis, prevention and treatment of bronchiolitis obliterans syndrome

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