Pulmonary Retransplantation: Predictors of Graft Function and Survival in 230 Patients

Novick, Richard J.; Stitt, Larry; Alkattan, Khaled; Klepetko, Walter; Schäfers, Hans Joachim; Duchatelle, J P; Khaghani, Asghar; Hardesty, Robert L.; Patterson, G.A.; Yacoub, Magdi H.

doi:10.1016/s0003-4975(97)01191-0

Cited by 130 publications

(91 citation statements)

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“…A number of single-centre observational studies and case series have evaluated the outcomes of retransplantation [141][142][143][144][145][146][147]. Survival rates have improved significantly in the modern era [145,146], and outcomes following re-transplantation for carefully selected patients with BOS (ambulatory patients selected via the same process used for first-time transplantation) may approach those of first-time lung transplants if performed by experienced centres [142,148].…”

Section: Re-transplantationmentioning

confidence: 99%

“…Our literature search identified four observational studies and three case series that reported the effects of re-transplantation on lung function and survival [141][142][143][144][145][146][147]. With respect to lung function, freedom from BOS following re-transplantation surgery for BOS was reported to be 85-90% at 1 year, 70-77% at 2-3 years and 50-77% at 4-5 years.…”

Section: Re-transplantationmentioning

confidence: 99%

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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: Re-transplantationmentioning

confidence: 99%

Section: Re-transplantationmentioning

confidence: 99%

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

et al. 2014

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“…Результаты ретрансплантации исследованы в многочисленных одноцентровых наблюдательных исследованиях и сериях случаев [141][142][143][144][145][146][147]. В последние годы выживаемость значи тельно улучшилась [145,146] и результаты ретранс плантации, выполненной в центрах с соответствую щим опытом у тщательно отобранных больных СОБ (по критериям, принятым для первичной тран сплантации), приближаются к таковым при первич ной трансплантации [142,148].…”

Section: клинические рекомендацииunclassified

“…Поиск литературы выявил четыре наблюдатель ных исследования и три серии случаев, в которых со общается о влиянии ретрансплантации на легочную функцию и выживаемость [141][142][143][144][145][146][147]. Если говорить о легочной функции, что устранение СОБ после ре трансплантации наблюдалось у 85 90 % больных СОБ через 1 год, у 70-77 % -через 2-3 года и у 50-77 % -через 4-5 лет.…”

Section: клинические рекомендацииunclassified

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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“…A number of single-center retrospective analyses have been reported, and actuarial survival has gradually improved [98,99]. Outcomes after retransplantation appear to be better when performed for BOS versus outcomes for PGD or other complications, and outcomes following retransplantation for carefully selected patients (ambulatory patients evaluated via the same selection process used for first-time transplantation) with BOS are expected to approach those of first-time lung transplants if performed by experienced centers.…”

Section: Retransplantationmentioning

confidence: 99%

Bronchiolitis obliterans syndrome

Meyer

2012

Curr Respir Care Rep

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Bronchiolitis obliterans syndrome (BOS) is thought to represent chronic allograft rejection. Primary graft dysfunction (PGD), acute cellular rejection (AR), lymphocytic bronchiolitis (LB), abnormal gastroesophageal reflux (GER) with microaspiration, and allograft infection have all been implicated as causes of BOS. Although BOS is generally considered to be caused by alloimmune responses to non-self tissue, more recent findings suggest that autoimmune responses to self-antigens and the triggering of innate immune responses to environment stimuli may play a significant role in the pathobiology of BOS. Effective treatment of BOS remains elusive, but azithromycin may stabilize and possibly improve FEV1 in patients who meet criteria for BOS, and gastric fundoplication may be beneficial if abnormal GER is detected. Augmented immunosuppression is generally ineffective, and other treatments such as total lymphoid irradiation (TLI) or extracorporeal photopheresis (ECP) may not have a significant impact on loss of function. Retransplantation can be considered in carefully selected patients.

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Pulmonary Retransplantation: Predictors of Graft Function and Survival in 230 Patients

Cited by 130 publications

References 15 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

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

Bronchiolitis obliterans syndrome

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