Is it bronchiolitis obliterans syndrome or is it chronic rejection: a reappraisal?
Chronic rejection (obliterative bronchiolitis) is the single most important cause of chronic allograft dysfunction and late mortality after lung transplantation. As this condition is difficult to prove using biopsy specimens, a clinical term, bronchiolitis obliterans syndrome (BOS) has been in use for >10 yrs to describe the progressive decrease of pulmonary function. However, before diagnosing a patient as having BOS, based on a sustained and progressive decrease in forced expiratory volume in one second and/or forced mid-expiratory flow between 25-75% of forced vital capacity, different confounding factors have to be eliminated. Treatment of BOS mainly consists of an increase or a change in the immunosuppressive drug regimen, which may lead to more pronounced infectious complications. Recently, two new options have become available to treat patients with BOS, treatment of gastro-oesophageal reflux and azithromycin. In the present paper, the authors give an overview of the current data on these two modalities, which may lead to a restoration of the pulmonary function in some of the patients, illustrating once more the fact that bronchitis obliterans syndrome is not always a manifestation of chronic rejection.
Verleden
G M
GM
University Hospital Gasthuisberg, Dept of Respiratory Diseases and Lung Transplantation Unit 49, Herestraat, B-3000 Leuven, Belgium. geert.verleden@uz.kuleuven.ac.be
Dupont
L J
LJ
Van Raemdonck
D E
DE
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D002908:Chronic Disease; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006084:Graft Rejection / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation; D012129:Respiratory Function Tests; D012307:Risk Factors; D013577:Syndrome
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D017963:Azithromycin