Bronchiolitis obliterans: pathogenesis, prevention, and management.
Increasing early success-post lung transplant has been tempered by the long-term development of histologic bronchiolitis obliterans (OB) or of the progressive airway obstruction which is called bronchiolitis obliterans syndrome (BOS). Multiple lines of evidence suggest that OB/BOS is due to an injury directed against the epithelial cells in the airways of the donor lung by the immune system of the recipient. Acute rejection is the strongest risk factor for the subsequent development of this process. Efforts to prevent or minimize acute rejection may reduce the prevalence of OB/BOS. Results of treatment with augmented immunosuppression have been disappointing but the treatment of complicating infections in the allograft can be beneficial. Multicenter studies are needed to assess the efficacy of new immunosuppressive agents in preventing or treating OB/BOS.
Paradis
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Oklahoma Transplantation Institute, INTEGRIS Baptist Medical Center, Oklahoma City 73112, USA. PARAIL@Integris-Health.com
D000818:Animals; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000276:immunology / Q000517:prevention & control* / Q000628:therapy; D004195:Disease Models, Animal; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy; D016040:Lung Transplantation / Q000009:adverse effects*; D012307:Risk Factors