Document Detail


Lung transplantation for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation: a single-center experience.
MedLine Citation:
PMID:  23274967     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Bronchiolitis obliterans (BO) is a detrimental late pulmonary complication after allogeneic hematopoietic stem cell transplantation (HCT) associated with chronic graft-versus-host disease (cGvHD). When systemic immunosuppressive treatment fails to improve, severe BO patients should be considered for lung transplantation (LuTX). We present seven patients undergoing LuTX for severe refractory BO after HCT.
METHODS: Seven patients with hematologic malignancies developed severe cGvHD with lung involvement presenting as BO after allogeneic HCT. Evaluation for LuTX was initiated after failure of a median of 4 immunosuppressive regimens.
RESULTS: Between 1996 and 2012, seven patients with severe refractory BO were evaluated for LuTX. The median time from HCT to diagnosis of chronic lung GvHD was 8.2 months (range, 3.7-16.6). At a median time of 18.1 months (range, 6-120) after diagnosis of BO, six patients received a bilateral sequential LuTX, and one patient received a single LuTX. Six postoperative courses were uneventful; the patient with single LuTX died from septic multiorgan failure. Three LuTX recipients had a mild acute rejection after one to three months after LuTX, and one patient experienced fatal chronic rejection and hemolytic uremic syndrome. At present, three (43%) LuTX recipients remain alive at a median observation time of 26 months (range, 1 month-16 years) after LuTX. The median overall survival from LuTX was 24 months (95% CI, 0.5-78); the median overall survival time after allogeneic HCT is 98 months (95% CI, 46-198).
CONCLUSION: This case series illustrates that LuTX is a possible therapeutic option for selected patients with severe treatment-refractory BO.
Authors:
Ursula M Vogl; Kazuhiro Nagayama; Marija Bojic; Mir Ali Reza Hoda; Walter Klepetko; Peter Jaksch; Sabine Dekan; Viktoria Siersch; Margit Mitterbauer; Peter Schellongowski; Hildegard T Greinix; Ventzislav Petkov; Axel Schulenburg; Peter Kalhs; Werner Rabitsch
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation     Volume:  95     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-22     Completed Date:  2013-04-10     Revised Date:  2013-10-07    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  623-8     Citation Subset:  IM    
Affiliation:
Department of Medicine I, Bone Marrow Transplantation Unit, Medical University Vienna, Währinger Gürtel 18-20 A-1090 Vienna, Austria.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Austria
Bronchiolitis Obliterans / diagnosis,  drug therapy,  etiology,  mortality,  surgery*
Chronic Disease
Drug Resistance
Female
Graft Rejection / etiology,  mortality
Graft vs Host Disease / diagnosis,  drug therapy,  etiology,  mortality,  surgery*
Hematopoietic Stem Cell Transplantation / adverse effects*
Hemolytic-Uremic Syndrome / etiology,  mortality
Humans
Immunosuppressive Agents / therapeutic use
Lung Transplantation* / adverse effects,  mortality
Male
Middle Aged
Multiple Organ Failure / etiology,  mortality
Survival Analysis
Time Factors
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents
Comments/Corrections
Comment In:
Transplantation. 2013 Aug 27;96(4):e21-2   [PMID:  23958883 ]
Transplantation. 2013 Aug 27;96(4):e22   [PMID:  23958884 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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