Markers of Bronchiolitis Obliterans Syndrome after Lung Transplant: Between Old Knowledge and Future Perspective

Abstract

Bronchiolitis obliterans syndrome (BOS) is the most common form of CLAD and is characterized by airflow limitation and an obstructive spirometric pattern without high-resolution computed tomography (HRCT) evidence of parenchymal opacities. Computed tomography and microCT analysis show abundant small airway obstruction, starting from the fifth generation of airway branching and affecting up to 40–70% of airways. The pathogenesis of BOS remains unclear. It is a multifactorial syndrome that leads to pathological tissue changes and clinical manifestations. Because BOS is associated with the worst long-term survival in LTx patients, many studies are focused on the early identification of BOS. Markers may be useful for diagnosis and for understanding the molecular and immunological mechanisms involved in the onset of BOS. Diagnostic and predictive markers of BOS have also been investigated in various biological materials, such as blood, BAL, lung tissue and extracellular vesicles. The aim of this review was to evaluate the scientific literature on markers of BOS after lung transplant. We performed a systematic review to find all available data on potential prognostic and diagnostic markers of BOS.

Instrumental Diagnostics of Bronchiolitis Obliterans in Children

“…У детей ОБ в большинстве случаев появляется после перенесенной тяжелой инфекции нижних дыхательных путей -постинфекционный облитерирующий бронхиолит [2]. Для данного клинического синдрома характерна прогрессирующая одышка, тахипноэ, стойкая гипоксемия, продуктивный кашель при отсутствии паренхиматозного поражения легких [4,5].…”

Worldwide Bronchiolitis obliterans research: A bibliometric analysis of the published literature between 2002 and 2022

“…[ 34 ] Computed tomography and micro-CT analysis show many small airway obstructions below the fifth-generation airway branches, with 40% to 70% of the airway affected to varying degrees, an outcome not explained by acute rejection, infection, or other coexisting disease. [ 35 ] Combining quantitative parametric response mapping with qualitative CT image features can improve diagnostic level for BOS. [ 36 ] One study found damage to the pIgR/IgA system in patients with BOS, and it was hypothesized that patient morbidity was associated with an increased likelihood of local infection.…”

Immune checkpoint analysis of T‐cell responses to pp65 and IE‐1 antigens in end‐stage lung diseases

“…1 Lung transplant is a therapeutic option in selected patients with end-stage lung disease. 2,3 The lungs are the only solid transplant organs exposed to the environment, including air pollution, bacteria and viruses. The large amount of lymphoid tissue in the lungs and heavy immunosuppression are associated with a high risk of contracting CMV infection, which occurs in 30%-80% of lung transplant patients.…”

“…Human cytomegalovirus (CMV) belongs to the family of herpes virus and is the most common infection after solid organ transplant 1 . Lung transplant is a therapeutic option in selected patients with end‐stage lung disease 2,3 . The lungs are the only solid transplant organs exposed to the environment, including air pollution, bacteria and viruses.…”