Mycophenolate mofetil for obliterative bronchiolitis syndrome after lung transplantation.
BACKGROUND
The development of obliterative bronchiolitis after lung transplantation portends a poor long-term outcome because of progressive decline in allograft function. There are currently no effective means of treating this condition.


METHODS
Thirteen patients in whom obliterative bronchiolitis syndrome developed after lung transplantation were treated with mycophenolate mofetil, an antimetabolite immunosuppressant, at a dose of 1.5 g orally twice daily. Patients were followed up clinically and with pulmonary function testing.


RESULTS
Duration of mycophenolate mofetil therapy ranged from 1 week to 24 months (mean duration, 11.4 months). Pulmonary function test results stabilized in the majority of patients with no significant further decline in forced expiratory volume in 1 second. Two patients died of progressive obliterative bronchiolitis, 1 patient is alive with progressive disease, and 1 patient died of an acute infection. The drug was discontinued in 2 additional patients. In no patient did severe leukopenia or cytomegalovirus infection develop; 1 patient had a fungal infection, and 7 patients experienced gastrointestinal side effects.


CONCLUSIONS
In the setting of obliterative bronchiolitis syndrome, mycophenolate mofetil is generally well tolerated and is associated with stabilization of pulmonary function test results. These findings suggest that the otherwise progressive process of obliterative bronchiolitis can be slowed.
Whyte
R I
RI
Department of Surgery, University of Michigan, Ann Arbor, USA.
Rossi
S J
SJ
Mulligan
M S
MS
Florn
R
R
Baker
L
L
Gupta
S
S
Martinez
F J
FJ
Lynch
J P
JP
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy*; D012129:Respiratory Function Tests
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid