Chronic lung allograft rejection: mechanisms and therapy.
Lung transplantation is a therapeutic option for patients with end-stage pulmonary disorders. Unfortunately, due to post-lung transplant complications, both infectious and noninfectious, it is only a treatment and not a cure. Importantly, despite induction combined with triple or quadruple maintenance immunosuppressive therapy, chronic lung rejection, in the form of obliterative bronchiolitis or its clinical correlate bronchiolitis obliterans syndrome (BOS), continues to be highly prevalent and is the major limitation to long-term survival. In this review we evaluate the presentation, diagnosis, histopathology, pathologic mechanisms, risk factors, and prevention/treatment options for BOS. A better understanding of the risk factors and how it relates to the pathologic mechanisms of chronic lung allograft rejection should lead to better pharmacologic targets to prevent/treat this syndrome without increasing the recipient's risk for infections.
Belperio
John A
JA
Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California, USA. jbelperio@mednet.ucla.edu
Weigt
S Samuel
SS
Fishbein
Michael C
MC
Lynch
Joseph P
JP
D000917:Antibody Formation; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000209:etiology / Q000276:immunology* / Q000628:therapy; D001999:Bronchoscopy; D002908:Chronic Disease; D016207:Cytokines / Q000276:immunology; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000276:immunology; D016040:Lung Transplantation; D012307:Risk Factors; D014184:Transplantation, Homologous
D016207:Cytokines; D036341:Intercellular Signaling Peptides and Proteins