Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation: a single‐center experience and review of literature

Lebeer, Marnix; Kaes, Janne; Lambrech, Maarten; Vanstapel, Arno; Beeckmans, Hanne; Ambrocio, Gene Philip Louie; Vanaudenaerde, Bart M.; Verleden, Stijn E.; Verbeken, Eric; Neyrinck, Arne; Ceulemans, Laurens J.; Raemdonck, Dirk Van; Verleden, Geert M.; Vos, Robin

doi:10.1111/tri.13544

Cited by 15 publications

(20 citation statements)

References 38 publications

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“…analyzed 16 cases of BOS treated with TLI and observed a significant monthly attenuation in FEV 1 decline from 246 ± 171 ml/month to 64 ± 171 ml/month 3 months before and after TLI (p = .0008) and 197 ± 116 ml/month versus 59 ± 91 ml/month 6 months before and after TLI (p = .002). 12 Likewise, Diamond et al observed a stop in FEV 1 decline after TLI in four rapid decliner patients who experienced a 40% decrease in FEV 1 3 months before the treatment. 13 Fisher et al…”

Section: Discussionmentioning

confidence: 92%

“…Slow decline was defined as an average monthly rate of FEV 1 decline <100 ml/mo, and rapid decline as an FEV 1 decline ≥100 ml/mo, both measured over 3 months prior to TLI. 12,13 Performance status was assessed using the Karnofsky Performance Status (KPS) prior to the start of the TLI. Subsequently, the patients were divided into groups with KPS >70 or ≤70.…”

Section: Methodsmentioning

confidence: 99%

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Efficacy and safety of total lymphoid irradiation in different chronic lung allograft dysfunction phenotypes

Geng-Cahuayme

Sáez-Giménez

Altabas-González

et al. 2023

Clinical Transplantation

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Total lymphoid irradiation (TLI) is an alternative treatment for chronic lung allograft dysfunction (CLAD). However, data regarding its efficacy and tolerance are scarce. This study included patients with CLAD treated with TLI at our center between 2011 and 2018. Clinical characteristics before and after TLI and related complications were analyzed. Forty patients with CLAD (twenty‐nine bronchiolitis obliterans syndrome [BOS], nine restrictive allograft syndrome [RAS], and two mixed) were included. Significant attenuation of the forced expiratory volume in 1‐sec (FEV1) decline slope was observed in all phenotypes, in both the BOS and RAS. The median FEV1 12, 6, and 3 months pre‐TLI were as follows: 1980 (IQR 1720‐2560), 1665 (IQR 1300‐2340) and 1300 (IQR 1040‐1740) ml (p < .001), while the median FEV1 at 3, 6, and 12 months post‐TLI was 1110 (IQR 810–1440), 1130 (IQR 860–1470), and 1115 (IQR 865–1490) ml (p = .769). No dropouts due to radiation toxicity were observed. The mean survival according to the Karnofsky Performance Status Scale (KPS) >70 or ≤70 at baseline was 1837 (IQR 259–2522) versus 298 (IQR 128–554) days (p < .0001), respectively. In conclusion, TLI may stop FEV1 decline in both BOS and RAS. Moreover, a good KPS score may be an important prognostic factor.

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Efficacy and safety of total lymphoid irradiation in different chronic lung allograft dysfunction phenotypes

Geng-Cahuayme

Sáez-Giménez

Altabas-González

et al. 2023

Clinical Transplantation

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“…Those who completed treatment had a decrease in rate of FEV 1 decline that was durable (65). Subsequent series show a similar stabilization in the rate of FEV 1 decline (66)(67)(68). However, leukopenia and infections are common side-effects of TLI (65,66).…”

Section: Total Lymphoid Irradiationmentioning

confidence: 90%

Management of chronic rejection after lung transplantation

Bedair¹,

Hachem²

2021

J Thorac Dis

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Outcomes after lung transplantation are limited by chronic lung allograft dysfunction (CLAD).The incidence of CLAD is high, and its clinical course tends to be progressive over time, culminating in graft failure and death. Indeed, CLAD is the leading cause of death beyond the first year after lung transplantation. Therapy for CLAD has been limited by a lack of high-quality studies to guide management. In this review, we will discuss the diagnosis of CLAD in light of the recent changes to definitions and will discuss the current clinical evidence available for treatment. Recently, the diagnosis of CLAD has been subdivided into bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). The current evidence for treatment of CLAD mainly revolves around treatment of BOS with more limited data existing for RAS. The best supported treatment to date for CLAD is the macrolide antibiotic azithromycin which has been associated with a small improvement in lung function in a minority of patients. Other therapies that have more limited data include switching immunosuppression from cyclosporine to tacrolimus, fundoplication for gastroesophageal reflux, montelukast, extracorporeal photopheresis (ECP), aerosolized cyclosporine, cytolytic anti-lymphocyte therapies, total lymphoid irradiation (TLI) and the antifibrotic agent pirfenidone. Most of these treatments are supported by case series and observational studies. Finally, we will discuss the role of retransplantation for CLAD.

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“…Alemtuzumab has been used for CLAD, with retrospective data demonstrating promise for stabilization of lung function, and ATG has been shown to demonstrate improved lung function in 40% of patients in one retrospective review, albeit with a high rate of serious adverse effects, including serum sickness, cytokine release syndrome, and infection (145,(169)(170)(171). ECP, TLI and retransplantation can also be considered for these patients (169,(172)(173)(174)(175)(176)(177)(178)(179)(180).…”

Section: Rejectionmentioning

confidence: 99%

Immunosuppression in lung transplantation: a narrative review

Atkinson¹,

Sharma²

2023

Curr Chall Thorac Surg

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Background and Objective: Lung transplantation has grown as a treatment option for patients with end stage lung disease. Unfortunately, median survival for lung transplant recipients remains low at 6.7 years. Acute rejection and chronic lung allograft dysfunction (CLAD) are among the main challenges to graft function and overall survival. Immunosuppression is utilized to reduce the rate of rejection, and can be utilized as a treatment for acute rejection and CLAD. The purpose of this review is to describe the immunosuppressive agents used in lung transplantation for induction therapy, maintenance therapy, and prevention of both acute and chronic allograft rejection.Methods: PubMed was searched using keywords including "lung transplantation, immunosuppression, induction, maintenance" from January 1985 to June 2022. Systematic reviews, randomized clinical trials, retrospective and cross-sectional studies, case series, and some animal studies were considered for inclusion in this review, with no language restrictions.

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Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation: a single‐center experience and review of literature

Cited by 15 publications

References 38 publications

Efficacy and safety of total lymphoid irradiation in different chronic lung allograft dysfunction phenotypes

Efficacy and safety of total lymphoid irradiation in different chronic lung allograft dysfunction phenotypes

Management of chronic rejection after lung transplantation

Immunosuppression in lung transplantation: a narrative review

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