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Minerva Pneumologica 2008 June;47(2):93-107

Copyright © 2008 EDIZIONI MINERVA MEDICA

language: English

Diagnosis and management of bronchiolitis obliterans syndrome in lung transplant recipients

Whitson B. A., D’Cunha J.

Department of Surgery Division of Thoracic and Foregut Surgery University of Minnesota, Minneapolis, MN, USA

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Human lung allograft transplants are plagued by chronic rejection. Bronchiolitis obliterans syndrome (BOS) development is directly, negatively correlated with chronic rejection and with overall survival. Even one episode of acute rejection can hasten bronchiolitis obliterans syndrome development. This article is a review of potential mechanisms for BOS progression, methods of diagnosis, and treatment options. Early diagnosis of BOS is made by routine surveillance spirometry with clinically indicated transbronchial biopsies and lavage. Further, acute rejection and primary graft dysfunction should be aggressively treated when identified. Prophylaxis against cytomegalovirus infection with ganciclovir may be indicated to prevent BOS progression. Potentially, the use of antimicrobial agents may limit the progression of BOS. Mycophenolate mofetil should be a part of maintenance immunosuppression regimens. For recipients with gastroesophageal reflux, early fundoplication can be effective. Retransplants are reserved for recipients with refractory conditions and acceptable operative risk.