Post-transplant bronchiolitis obliterans

Abstract

Over the last decade, improvements in surgical techniques, lung preservation, immunosuppression, and management of ischaemia/reperfusion injury and infections have made intermediate-term survival after lung transplantation an achievable goal. However, chronic allograft dysfunction in the form of bronchiolitis obliterans remains a major hurdle that threatens both the quality of life and long-term survival of the recipients. It affects up to 50-60% of patients who survive 5 yrs after surgery, and it accounts for w30% of all deaths occurring after the third postoperative year.This article discusses the alloimmune-dependent and -independent risk factors for bronchiolitis obliterans, the current understanding of the pathogenesis of bronchiolitis obliterans based on results of animal and human studies, the clinical staging of the complication, strategies that may contribute to the prevention and/or early detection of bronchiolitis obliterans, and suggestions for future research.

Impact of Sinus Surgery on Pseudomonal Airway Colonization, Bronchiolitis Obliterans Syndrome and Survival in Cystic Fibrosis Lung Transplant Recipients

“…Second, we did not look for all confounders, which could have influenced survival and particularly the development of BOS. Lymphocytic bronchitis/bronchiolitis are recognized as classic immunological risk factors [24,25], and other non-immunological risk factors have been proposed, such as ischaemic reperfusion, early non-specific bronchial hyperresponsiveness, donor and recipient age, graft ischaemic time, gastro-oesophageal reflux and bacterial/fungal/non-CMV viral infections [26]. Due to our small cohort, a reliable statistical analysis for these risk factors was difficult.…”

Posttransplant Bronchiolitis Obliterans Syndrome Is Associated with Bronchial Epithelial to Mesenchymal Transition

“…BOS thus appears to represent a final common pathway of response to a variety of noxious insults. This heterogeneity of associations has made it difficult to determine a single treatment strategy that will benefit all patients (2). Identifying the origin of activated airway fibroblasts may be a key step in achieving this aim.…”

Analysis of cytokine pattern in exhaled breath condensate of lung transplant recipients with bronchiolitis obliterans syndrome

“…Bronchiolitis obliterans syndrome (BOS) is a fibroproliferative process that manifests clinically as chronic graft deterioration after lung transplantation [1]. Development of BOS is commonly associated with the up-regulation of a large number of chemokines, cytokines and pro-fibrotic growth factors.…”