Targeting allograft injury and inflammation in the management of post-lung transplant bronchiolitis obliterans syndrome.
Chronic allograft dysfunction, manifesting as bronchiolitis obliterans syndrome (BOS), is the major cause of morbidity and mortality in human lung transplant recipients. While alloimmunity has a definite role, there is increasing interest in overall allograft injury and subsequent inflammation and remodeling. This review deals with nonalloimmune factors that may potentiate alloimmune injury. We discuss infection and reflux/aspiration as examples of allograft injury, which may lead to chronic loss of graft function and BOS. Surgical and nonsurgical treatments aimed at preventing these insults and improving survival are considered. The need for further evidence, including randomized-controlled trials, to evaluate the role of medical and surgical therapies is emphasized by the current literature.
Robertson
A G N
AG
Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle University, Newcastle, UK.
Griffin
S M
SM
Murphy
D M
DM
Pearson
J P
JP
Forrest
I A
IA
Dark
J H
JH
Corris
P A
PA
Ward
C
C
D017963:Azithromycin / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000209:etiology; D016905:Gram-Negative Bacterial Infections / Q000150:complications; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008171:Lung Diseases / Q000150:complications / Q000382:microbiology; D016040:Lung Transplantation / Q000009:adverse effects*; D011014:Pneumonia / Q000382:microbiology; D011015:Pneumonia, Aspiration / Q000209:etiology; D014184:Transplantation, Homologous / Q000276:immunology
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017963:Azithromycin