title: Lung transplantation for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation:  a single-center experience.
abstract: BACKGROUND
  Bronchiolitis obliterans (BO) is a detrimental late pulmonary complication after allogeneic hematopoietic stem cell transplantation (HCT) associated with chronic graft-versus-host disease (cGvHD). When systemic immunosuppressive treatment fails to improve, severe BO patients should be considered for lung transplantation (LuTX). We present seven patients undergoing LuTX for severe refractory BO after HCT.
  
  
  METHODS
  Seven patients with hematologic malignancies developed severe cGvHD with lung involvement presenting as BO after allogeneic HCT. Evaluation for LuTX was initiated after failure of a median of 4 immunosuppressive regimens.
  
  
  RESULTS
  Between 1996 and 2012, seven patients with severe refractory BO were evaluated for LuTX. The median time from HCT to diagnosis of chronic lung GvHD was 8.2 months (range, 3.7-16.6). At a median time of 18.1 months (range, 6-120) after diagnosis of BO, six patients received a bilateral sequential LuTX, and one patient received a single LuTX. Six postoperative courses were uneventful; the patient with single LuTX died from septic multiorgan failure. Three LuTX recipients had a mild acute rejection after one to three months after LuTX, and one patient experienced fatal chronic rejection and hemolytic uremic syndrome. At present, three (43%) LuTX recipients remain alive at a median observation time of 26 months (range, 1 month-16 years) after LuTX. The median overall survival from LuTX was 24 months (95% CI, 0.5-78); the median overall survival time after allogeneic HCT is 98 months (95% CI, 46-198).
  
  
  CONCLUSIONS
  This case series illustrates that LuTX is a possible therapeutic option for selected patients with severe treatment-refractory BO.
authors.affiliation: Department of Medicine I, Bone Marrow Transplantation Unit, Medical University Vienna, Währinger Gürtel 18-20 A-1090 Vienna, Austria.
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Vogl
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nagayama
authors.forename: Marija
authors.initials: M
authors.lastname: Bojic
authors.forename: Mir Ali Reza
authors.initials: MA
authors.lastname: Hoda
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
authors.forename: Peter
authors.initials: P
authors.lastname: Jaksch
authors.forename: Sabine
authors.initials: S
authors.lastname: Dekan
authors.forename: Viktoria
authors.initials: V
authors.lastname: Siersch
authors.forename: Margit
authors.initials: M
authors.lastname: Mitterbauer
authors.forename: Peter
authors.initials: P
authors.lastname: Schellongowski
authors.forename: Hildegard T
authors.initials: HT
authors.lastname: Greinix
authors.forename: Ventzislav
authors.initials: V
authors.lastname: Petkov
authors.forename: Axel
authors.initials: A
authors.lastname: Schulenburg
authors.forename: Peter
authors.initials: P
authors.lastname: Kalhs
authors.forename: Werner
authors.initials: W
authors.lastname: Rabitsch
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001317:Austria; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002908:Chronic Disease; D004351:Drug Resistance; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents