Bronchiolitis obliterans in recipients of single, double, and heart-lung transplantation.
Thirty-two recipients of single, double, or heart-lung transplantation followed-up for at least 3 months posttransplant were retrospectively reviewed to assess the frequency, predictors, and risk factors associated with the development of bronchiolitis obliterans (BO). A clinical definition for the diagnosis of BO was made using the following criteria: persistent and progressive decline in FEF25-75, associated with normal results of cytologic and microbiologic studies for significant pathogens in bronchoalveolar lavage fluid, with a normal chest radiograph. This was correlated with histologic diagnosis and patient outcome. Sixteen (50%) of the patients developed BO, and this was associated with a 56% mortality. All but 1 patient with histologic BO had a clinical diagnosis of BO made (often months) prior to diagnostic biopsy. No patients with normal histologic findings had a clinical diagnosis of BO. More than 3 episodes of histologically documented acute rejections in any 12-month period were eventually associated with a 100% incidence of BO. Cytomegalovirus occurred with greater frequency in patients with BO, and in most cases, preceded or occurred concomitantly with the diagnosis of acute rejection or BO.
Keller
C A
CA
Department of Medicine, Saint Louis University Health Sciences Center, MO, USA.
Cagle
P T
PT
Brown
R W
RW
Noon
G
G
Frost
A E
AE
D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology*; D005260:Female; D006084:Graft Rejection; D016041:Heart-Lung Transplantation / Q000009:adverse effects; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013147:Spirometry