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.

Extracorporeal CO2removal as bridge to lung transplantation in life-threatening hypercapnia

“…The authors found similar effects of ILA therapy on CO 2 removal, correction of acidosis, and the resulting reduction of ventilator settings, when compared to our data [6]. In the meantime, several centers have reported on a total of 55 hypercapnic patients who underwent ECCO2-R by a/v ILA as attempted bridge to LTX [6][7][8][9]30,31]. However, unfortunately important outcomes including rate of successful LTX, short-and longterm survival have not been indicated in several of these reports ( Table 5).…”

Pumpless extracorporeal interventional lung assist for bronchiolitis obliterans after allogenic peripheral blood stem cell transplantation for acute lymphocytic leukemia

“…Despite the many clinical studies on treatment strategies for BO after HSCT, there is still no definitive treatment. Treatment of BO consists of corticosteroid and immunosuppressive drugs such as cyclosporine A or tacrolimus [9]. When the conventional immunosuppressive treatment is ineffective, the 2-year survival rate is 20% [10].…”

“…When the conventional immunosuppressive treatment is ineffective, the 2-year survival rate is 20% [10]. A few papers have recently reported on lung transplantation (LT) for BO complicated by HSCT, and suggested LT as an effective therapy for respiratory failure secondary to BO [9]. However, LT leads to high post-operative risk of rejection and infection, and finding a suitable lung donor is difficult.…”

Update on extracorporeal carbon dioxide removal: a comprehensive review on principles, indications, efficiency, and complications

“…94 Some case series were published during the next years using the same device or the Decap Smart © system. 95–99 Effective correction of acidosis was possible in nearly all cases, while outcome was less convincing. Our own group published a series of 20 patients undergoing ECCO 2 R as a bridge to LTX.…”