Lung transplantation for bronchiolitis obliterans after allogenic bone marrow transplantation.
BACKGROUND
Bronchiolitis obliterans (BO) occurring after allogeneic bone marrow transplant (ABMT) may be an expression of lung damage of multifactorial origins. At present, it is not a usual condition for lung transplant (LT), accounting for <1% of all indications in the international registry. We sought, to describe the clinical features and outcomes of patients undergoing LT for BO after ABMT in our group.


METHODS
We undertook a cross-sectional study of patients with an indication for LT due to BO after ABMT from the beginning of our program. We recorded the type of transplant, patient age, clinical course, functional outcome, and survival.


RESULTS
Among 313 LT, 13 cases (4.2%) were due to BO, including 3 after ABMT (0.96%). ABMT was indicated after bone marrow aplasia in 2 cases and acute myeloid leukemia in the other patient. The patients were 2 men (both 35 years old) and 1 woman, aged 25 years. All subjects received double elective LT at 24, 20, and 9 years post ABMT. At the time of LT, all displayed severe obstructive ventilatory defects with a forced expiratory volume in 1 second (FEV1)<30% and partial respiratory insufficiency. The initial immunosuppression was cyclosporine, mycophenolate mofetil, and steroids in all cases. Two of the subjects required changes in the immunosuppressive regimen: 1 due to chronic graft rejection with subsequent functional recovery and the other due to hematologic and neurologic toxicity. After 96, 37, and 9 months, all the patients were alive with baseline dyspnea of functional class 0 and a FEV1 of about 68%.


CONCLUSIONS
LT is an effective therapy in terms of lung function and survival for patients with respiratory failure secondary to the development of BO after ABMT.
Department of Pneumology, Lung Transplant Unit, Reina Sofia University Hospital, Córdoba, Spain. javierredel@msn.com
J
J
Redel-Montero
C
C
Bujalance-Cabrera
J-M
JM
Vaquero-Barrios
F
F
Santos-Luna
M
M
Arenas-De Larriva
P
P
Moreno-Casado
D
D
Espinosa-Jiménez
D000328:Adult; D016026:Bone Marrow Transplantation; D001989:Bronchiolitis Obliterans / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male