title: Bronchiolitis obliterans syndrome is not specific for bronchiolitis obliterans in pediatric lung transplant.
abstract: BACKGROUND
  Bronchiolitis obliterans (BO) is the leading cause of mortality beyond the first year after pediatric lung transplant, but the performance of an open lung biopsy is often required for diagnosis. Bronchiolitis obliterans syndrome (BOS) is a clinical diagnosis based on spirometric data that is the accepted standard for staging chronic allograft dysfunction.
  
  
  METHODS
  We determined the sensitivity, specificity, and positive and negative predictive values of BOS for predicting BO in children. A chart review was conducted on 139 open lung biopsies and 43 lung explants performed at our center from 1990 through June 2010 in pediatric recipients of lung transplants. Results were excluded from analysis if insufficient data existed to calculate a stable BOS stage before biopsy/explant.
  
  
  RESULTS
  The criteria for inclusion in the study were met by 67 open lung biopsies and 31 lung explants. The sensitivity, specificity, positive predictive value, and negative predictive value of BOS for predicting BO were 91.0%, 25.8%, 72.6%, and 57.1%.
  
  
  CONCLUSIONS
  We found that early declines in lung function are sensitive, but not specific, for BO. The low specificity of BOS for identifying BO illustrates the challenge facing clinicians in determining the etiology of pulmonary decline after lung transplant.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Christopher
authors.initials: C
authors.lastname: Towe
authors.affiliation: Department of Pediatrics, Scott & White Hospital, Temple, Texas.
authors.forename: A
authors.initials: A
authors.lastname: Chester Ogborn
authors.affiliation: Department of Pediatrics.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ferkol
authors.affiliation: Department of Pediatrics.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sweet
authors.affiliation: Department of Cardiothoracic Surgery, St. Louis University, St. Louis, Missouri.
authors.forename: Charles
authors.initials: C
authors.lastname: Huddleston
authors.affiliation: Department of Pathology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Frances
authors.initials: F
authors.lastname: White
authors.affiliation: Department of Pediatrics. Electronic address: Faro_A@kids.wustl.edu.
authors.forename: Albert
authors.initials: A
authors.lastname: Faro
mesh_terms: D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000473:pathology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013577:Syndrome
keywords: allograft dysfunction; bronchiolitis obliterans; bronchiolitis obliterans syndrome; explant; lung transplant; open lung biopsy; pediatric; spirometry