Ischemia-reperfusion injury after lung transplantation increases risk of late bronchiolitis obliterans syndrome.
BACKGROUND
Bronchiolitis obliterans syndrome (BOS) is the most common cause of long-term morbidity and mortality after lung transplantation. Our hypothesis was that early ischemia-reperfusion injury after lung transplantation increases the risk of BOS.


METHODS
Data on 134 patients who had lung transplantation between January 1, 1990 and January 1, 2000, was used for univariate and multivariate logistic regression analysis.


RESULTS
After lung transplantation, 115 patients (115 of 134, 86%) survived more than 3 months. In that group, 41 patients developed BOS, of which 23 had progressive disease. Univariate analysis revealed that ischemia-reperfusion injury (p = 0.017) and two or more acute rejection episodes (p = 0.032) were predictors of BOS onset, whereas ischemia-reperfusion injury (p = 0.011) and cytomegalovirus infection (p = 0.009) predicted progressive BOS. Multivariate logistic regression analysis showed that ischemia-reperfusion injury was an independent predictor for both BOS development and BOS progression. Two or more acute rejection episodes were also an independent predictor of BOS development, whereas cytomegalovirus infection was an independent predictor of progressive BOS.


CONCLUSIONS
Ischemia-reperfusion injury increases the risk of BOS after lung transplantation.
Fiser
Steven M
SM
Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Tribble
Curtis G
CG
Long
Stewart M
SM
Kaza
Aditya K
AK
Kern
John A
JA
Jones
David R
DR
Robbins
Mark K
MK
Kron
Irving L
IL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000209:etiology*; D002648:Child; D003586:Cytomegalovirus Infections / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection / Q000150:complications; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000209:etiology; D015427:Reperfusion Injury / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors