title: An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome.
abstract: Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS. A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations. The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of post-transplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS. The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention.
authors.affiliation: School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA kcm@medicine.wisc.edu.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Meyer
authors.affiliation: School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raghu
authors.affiliation: University of Leuven, Leuven, Belgium.
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.affiliation: Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Corris
authors.affiliation: Great Ormond Street Hospital for Children, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Aurora
authors.affiliation: Boston University Medical Center, Boston, MA, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Wilson
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Jan
authors.initials: J
authors.lastname: Brozek
authors.affiliation: The Lung Transplant Unit, St Vincents Hospital, Sydney, Australia.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Glanville
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000628:therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D019468:Disease Management; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000601:surgery; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D016040:Lung Transplantation; D012086:Reoperation; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D017963:Azithromycin; D016572:Cyclosporine; D016559:Tacrolimus