Obliterative bronchiolitis in lung allografts removed at retransplant for intractable airway problems.
OBJECTIVE
The role of large airway ischaemia, with resultant airway narrowing, in the development of post-lung transplant bronchiolitis obliterans has not been defined. A determination of clinical bronchiolitis obliterans syndrome (BOS), which is defined as a decline in FEV(1) from a stable post-transplant baseline, is difficult in the setting of airway complications. The aim of this study was to assess the evidence for histological bronchiolitis obliterans in lung allografts removed during retransplantation for severe recurrent airway narrowing.


METHODS
Case records and histological findings in allograft lungs removed at retransplantation were retrospectively reviewed.


RESULTS
Five lung transplant recipients, who had undergone retransplantation because of severe recalcitrant airway stenosis, were identified. In each case, explant allograft lung pathology revealed evidence of bronchiolitis obliterans.


CONCLUSIONS
There is a possible link between airway ischaemia, large airway stenosis and the development of bronchiolitis obliterans, which is the most common cause of death in lung transplant recipients after the first year. These findings may provide an impetus for evaluation of the role of bronchial artery revascularization techniques in the prevention of bronchiolitis obliterans.
Akindipe
Olufemi
O
Divisions of Pulmonary and Critical Care Medicine, University of Florida Health Sciences Center, Gainesville, Florida 32610-0395, USA. akindoa@medicine.ufl.edu
Fernandez-Bussy
Sebastian
S
Jantz
Michael
M
Lu
Li
L
Deem
Amy
A
Swafford
Wendy
W
Staples
Edward
E
Baz
Maher
M
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors