Risk factors for the development of bronchiolitis obliterans syndrome after lung transplantation

Kroshus, Timothy J.; Kshettry, Vibhu R.; Savik, Kay; John, Ranjit; Hertz, Marshall I.; Bolman, R. Morton

doi:10.1016/s0022-5223(97)70144-2

Cited by 237 publications

(140 citation statements)

References 18 publications

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“…The lack of effect of graft ischaemic time, recipient sex, and recipient age upon development of primary graft failure has been reported by other groups, although it has been suggested that there is a time threshold for graft ischaemic time beyond which acute lung injury is more likely to occur [17,18]. Subsequent development of BOS has been related to early acute rejection, and no operative factors have been identified as risk factors for the development of this condition [19,20].…”

Section: Discussionmentioning

confidence: 94%

The effect of prelung transplant clinical status on post-transplant survival of children with cystic fibrosis

Aurora¹,

Gassas²,

Ehtisham³

et al. 2000

Eur Respir J

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The aim of this study was to determine whether transplanting paediatric cystic fibrosis (CF) patients later in the course of their disease was detrimental to their post‐transplant survival. Data was collected from 51 children with CF undergoing lung or heart‐lung transplantation May 1988–March 1999. The following risk factors were tested by Cox proportional hazards modelling: age at transplant; sex; donor/recipient sex mismatch; donor/recipient cytomegalovirus (CMV) mismatch; cold and warm graft ischaemic times; and donor age. Pretran‐splant forced expiratory volume in one second (FEV1), minimum oxygen saturation obtained during 12 min walk (Sa,O2min), and a survival probability score (SP) calculated from FEV1, age adjusted resting heart rate, age, sex, blood haemoglobin (Hb), and serum albumin were then added to the model. None of the risk factors were significantly correlated with death during the study period. No evidence that clinical status prior to transplant has any effect upon the post‐transplant survival of children with cystic fibrosis was found.

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Section: Discussionmentioning

confidence: 94%

The effect of prelung transplant clinical status on post-transplant survival of children with cystic fibrosis

Aurora¹,

Gassas²,

Ehtisham³

et al. 2000

Eur Respir J

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“…Immunologic factors suggested to have a role in the development of BOS include acute rejection, 25,26 lymphocytic bronchitis, 27,28 HLA mismatch [29][30][31] and CMV pneumonitis, 8,[32][33][34] and non-immunologic factors include ischemia, 30 donor age 35 and recipient age. 36 In the present study we found that infections, an indication for transplant of emphysema, and female recipient status were also independent predictors of earlier development of BOS2, whereas female recipient status was associated with earlier onset of BOS3.…”

Section: Discussionmentioning

confidence: 99%

De novo donor HLA-specific antibodies predict development of bronchiolitis obliterans syndrome after lung transplantation

Safavi

Robinson

Soresi

et al. 2014

The Journal of Heart and Lung Transplantation

115

104

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(2014) De novo donor HLA-specific antibodies predict development of bronchiolitis obliterans syndrome after lung transplantation. The Journal of Heart and Lung Transplantation, 33 (12). pp. 1273 -1281 . ISSN 1053 -2498 This version is available from Sussex Research Online: http://sro.sussex.ac.uk/56766/ This document is made available in accordance with publisher policies and may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the URL above for details on accessing the published version. Copyright and reuse:Sussex Research Online is a digital repository of the research output of the University.Copyright and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable, the material made available in SRO has been checked for eligibility before being made available.Copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. There was a significant reduction in patient survival associated with de novo DSA (HR ¼ 1.886, p ¼ 0.047). In multivariable analyses, de novo DSA was an independent predictor for development of all stages of BOS as well as an independent predictor of poor patient survival. CONCLUSIONS: De novo DSA is a major risk factor for progression to BOS and shorter patient survival. Treatments to remove antibodies or limit antibody-mediated damage could be considered when DSA are first detected. However, a randomized, controlled trial of treatment options would enable a clearer understanding of the benefits, if any, of antibody-removal therapies.

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“…Although early reports linked allograft invasive CMV pneumonitis (CMV-P) to an increased risk for BOS, the strongest evidence of this association comes from the preprophylaxis era (3,4). Small retrospective studies indicated that routine use of ganciclovir for CMV prophylaxis perioperatively decreased CMV disease and delayed the onset of BOS as compared with no prophylaxis (5,6).…”

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confidence: 99%

Cytomegalovirus Pneumonitis Is a Risk for Bronchiolitis Obliterans Syndrome in Lung Transplantation

Snyder¹,

Finlen-Copeland²,

Turbyfill³

et al. 2010

Am J Respir Crit Care Med

146

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Rationale: Cytomegalovirus pneumonitis is one of the most prevalent opportunistic infections after lung transplantation. Early studies reported that cytomegalovirus pneumonitis was a risk factor for chronic allograft dysfunction. More recently, in the era of routine prophylaxis and ganciclovir treatment, the adverse impact of treated cytomegalovirus pneumonitis on bronchiolitis obliterans syndrome has been challenged. Objectives: We hypothesized that cytomegalovirus pneumonitis contributes to adverse outcomes in the current antiviral era. We sought to define the impact of treated cytomegalovirus pneumonitis on bronchiolitis obliterans syndrome and survival in a large singlecenter cohort (n 5 231) of consecutive patients undergoing lung transplantation from 2000 to 2004, all receiving short-course ganciclovir prophylaxis. Methods: Transbronchial biopsies were performed at defined intervals with prospective cytomegalovirus immunostaining on every biopsy (n 5 1,887). Cox proportional hazards models were used to assess the relationship between treated cytomegalovirus pneumonitis and clinical outcomes. Measurements and Main Results: Forty-nine (21%) recipients developed cytomegalovirus pneumonitis a median of 106 days after transplantation. Treated cytomegalovirus pneumonitis within the first 6 months after transplantation significantly increased the risk for bronchiolitis obliterans syndrome (P 5 0.001; hazard ratio, 2.19; 95% confidence interval, 1.36-3.51) and post-transplantation death (P 5 0.02; hazard ratio, 1.89; 95% confidence interval, 1.11-3.23). This risk persisted when cytomegalovirus pneumonitis was considered as a time-dependent predictor as well as in multivariable models controlling for other risk factors. Conclusions: Cytomegalovirus pneumonitis affects more than 20% of lung transplant recipients. Despite treatment, it increases the risk for bronchiolitis obliterans syndrome and death. More effective preventive strategies for cytomegalovirus pneumonitis are needed to improve long-term outcomes after lung transplantation.

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Risk factors for the development of bronchiolitis obliterans syndrome after lung transplantation

Cited by 237 publications

References 18 publications

The effect of prelung transplant clinical status on post-transplant survival of children with cystic fibrosis

The effect of prelung transplant clinical status on post-transplant survival of children with cystic fibrosis

De novo donor HLA-specific antibodies predict development of bronchiolitis obliterans syndrome after lung transplantation

Cytomegalovirus Pneumonitis Is a Risk for Bronchiolitis Obliterans Syndrome in Lung Transplantation

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