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Review
. 2013 Jun;34(3):336-51.
doi: 10.1055/s-0033-1348467. Epub 2013 Jul 2.

Bronchiolitis obliterans syndrome: the Achilles' heel of lung transplantation

S Samuel Weigt  1 , Ariss DerHovanessian, W Dean Wallace, Joseph P Lynch 3rd, John A Belperio
Affiliations
Review

Bronchiolitis obliterans syndrome: the Achilles' heel of lung transplantation

S Samuel Weigt et al. Semin Respir Crit Care Med. 2013 Jun.

Abstract

Lung transplantation is a therapeutic option for patients with end-stage pulmonary disorders. Unfortunately, chronic lung allograft dysfunction (CLAD), most commonly manifest as bronchiolitis obliterans syndrome (BOS), continues to be highly prevalent and is the major limitation to long-term survival. The pathogenesis of BOS is complex and involves alloimmune and nonalloimmune pathways. Clinically, BOS manifests as airway obstruction and dyspnea that are classically progressive and ultimately fatal; however, the course is highly variable, and distinguishable phenotypes may exist. There are few controlled studies assessing treatment efficacy, but only a minority of patients respond to current treatment modalities. Ultimately, preventive strategies may prove more effective at prolonging survival after lung transplantation, but their remains considerable debate and little data regarding the best strategies to prevent BOS. A better understanding of the risk factors and their relationship to the pathological mechanisms of chronic lung allograft rejection should lead to better pharmacological targets to prevent or treat this syndrome.

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Figures

Fig. 1
Fig. 1
Complete fibrous obliteration of small bronchiole with residual elastic layer and atrophied smooth muscle (hematoxylin and eosin stain; original magnification ×400).
Fig. 2
Fig. 2
Partial obliteration of bronchiole with mononuclear cell infiltration in subepithelial fibrosis (combined Masson trichrome and elastic van Gieson stain; original magnification ×40).
Fig. 3
Fig. 3
Perivascular lymphoid infiltrate with rare eosinophils, consistent with mild acute cellular rejection (hematoxylin and eosin stain; original magnification ×200).
Fig. 4
Fig. 4
Circumferential lymphoid infiltration around small bronchiole with frequent eosinophils, consistent with high-grade small airway inflammation (grade B2R) (hematoxylin and eosin stain; original magnification ×400).
Fig. 5
Fig. 5
Diffuse and back-to-back capillary neutrophils (hematoxylin and eosin stain; original magnification ×600).
See this image and copyright information in PMC

References

    1. Christie JD, Edwards LB, Kucheryavaya AY, et al. International Society of Heart and Lung Transplantation The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant. 2012;31(10):1073–1086. - PubMed
    1. Knoop C, Estenne M. Acute and chronic rejection after lung transplantation. Semin Respir Crit Care Med. 2006;27(5):521–533. - PubMed
    1. Vermeulen KM, Groen H, van der Bij W, Erasmus ME, Koëter GH, TenVergert EM. The effect of bronchiolitis obliterans syndrome on health related quality of life. Clin Transplant. 2004;18(4):377–383. - PubMed
    1. van den Berg JW, van Enckevort PJ, TenVergert EM, Postma DS, van der Bij W, Koëter GH. Bronchiolitis obliterans syndrome and additional costs of lung transplantation. Chest. 2000;118(6):1648–1652. - PubMed
    1. Estenne M, Maurer JR, Boehler A, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant. 2002;21(3):297–310. - PubMed