title: Lung transplantation for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation.
abstract: Bronchiolitis obliterans (BO) is a late onset complication of allogeneic hematopoietic stem cell transplantation (HSCT), and treatment outcome is dismal if it does not respond to immunosuppressive therapy. A 21-year-old male diagnosed with acute myeloid leukemia received an allogeneic HSCT from human leukocyte antigen- identical sibling donor. Twenty one months after transplantation, he developed progressive dyspnea and was diagnosed BO. Despite standard immunosuppressive therapy, the patient rapidly progressed to respiratory failure and Novalung® interventional lung-assist membrane ventilator was applied in the intensive care unit. Three months after the diagnosis of BO, the patient underwent bilateral lung transplantation (LT) and was eventually able to wean from the ventilator and the Novalung®. Since the LT, the patient has been under a strict rehabilitation program in order to overcome a severe lower extremity weakness and muscle atrophy. Histologic findings of the explanted lungs confirmed the diagnosis of BO. Nine months after the LT, the patient showed no signs of rejection or infectious complications, but still required rehabilitation treatment. This is the first LT performed in a patient with BO after allogeneic HSCT in Korea. LT can be an effective therapy in terms of survival for patients with respiratory failure secondary to development of BO following HSCT.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yu Ri
authors.initials: YR
authors.lastname: Kim
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Haam
authors.forename: Yoon Ghil
authors.initials: YG
authors.lastname: Park
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Lim
authors.forename: Yoo Mi
authors.initials: YM
authors.lastname: Park
authors.forename: Hyo Chae
authors.initials: HC
authors.lastname: Paik
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000628:therapy*; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D055815:Young Adult