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Review
. 2020 Feb;33(2):216-228.
doi: 10.1111/tri.13544. Epub 2019 Nov 19.

Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation: a single-center experience and review of literature

Marnix Lebeer  1 , Janne Kaes  2 , Maarten Lambrech  3 , Arno Vanstapel  1   2 , Hanne Beeckmans  1 , Gene P L Ambrocio  1 , Bart M Vanaudenaerde  2 , Stijn E Verleden  2 , Eric K Verbeken  4 , Arne P Neyrinck  2   5 , Laurens J Ceulemans  2   6 , Dirk E Van Raemdonck  2   6 , Geert M Verleden  1   2 , Robin Vos  1   2 ; Leuven Lung Transplant Group
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Free article
Review

Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation: a single-center experience and review of literature

Marnix Lebeer et al. Transpl Int. 2020 Feb.
Free article

Abstract

Limited results about treatment with total lymphoid irradiation (TLI) in lung transplant (LTx) recipients suffering from progressive bronchiolitis obliterans syndrome (BOS) have been reported. We performed a retrospective analysis of all LTx recipients undergoing TLI for progressive BOS in our center, focusing on long-term outcomes regarding overall survival and lung allograft function. Treatment with TLI (2004-2017, n = 20, 1 BOS stage 1, 6 BOS stage 2, and 13 BOS stage 3) resulted in significant attenuation of the FEV1 -decline in the majority of patients, mainly in those with a rapid decline (P = 0.0005). This allowed bridging to redo-transplantation in five patients. However, three patients progressed from BOS to RAS following prior TLI. Overall patient survival was 44% at 2 years post-TLI and 38% after 17 years. Generally, TLI was well tolerated, with limited side effects and no serious adverse events. TLI may attenuate the decline in FEV1 of LTx recipients with rapid progressive BOS and could thus help to bridge selected patients to redo-transplantation.

Keywords: bronchiolitis obliterans syndrome; chronic lung allograft dysfunction; lung transplantation; outcome; restrictive allograft syndrome; total lymphoid irradiation.

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References

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