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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
Verleden G. M., Dupont L. J., D. Van Raemdonck E. M.
Lung and heart-lung transplantation are currently recognized as effective treatment modalities for selected patients with end-stage lung or heart-lung disease. Although the survival rates have improved in recent years, long-term survival remains inferior compared to other solid organ transplantations, such as kidney, heart and liver. The main reason is the development of chronic rejection, which histologically manifests as obliterative bronchiolitis (OB), a process that leads to airways obstruction, with a gradual decline in pulmonary function tests. Because of the difficulties in obtaining good pathological specimens, a clinical grading system, called bronchiolitis obliterans syndrome (BOS) has been introduced, divided into 4 and, more recently, 5 categories, depending on the severity of airflow obstruction. Extensive research efforts have attempted to unravel the pathophysiology of OB and identify key cytokines and growth factors involved in this process. Once established, the response to treatment is very poor, although recently treatment with azithromycine, a neo-macrolide antibiotic with extensive anti-inflammatory effects, has proven to be effective in at least some of these patients. This paper intends to review the current knowledge of BOS and OB after heart-lung and lung transplantation.