Is it bronchiolitis obliterans syndrome or is it chronic rejection: A reappraisal?

  • Verleden G
  • Dupont L
  • Van Raemdonck D
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Chronic rejection (obliterative bronchiolitis) is the single most important cause of chronic allograft dysfunction and late mortality after lung transplantation. As this condition is difficult to prove using biopsy specimens, a clinical term, bronchiolitis obliterans syndrome (BOS) has been in use for >10 yrs to describe the progressive decrease of pulmonary function. However, before diagnosing a patient as having BOS, based on a sustained and progressive decrease in forced expiratory volume in one second and/or forced mid-expiratory flow between 25-75% of forced vital capacity, different confounding factors have to be eliminated. Treatment of BOS mainly consists of an increase or a change in the immunosuppressive drug regimen, which may lead to more pronounced infectious complications. Recently, two new options have become available to treat patients with BOS, treatment of gastro-oesophageal reflux and azithromycin. In the present paper, the authors give an overview of the current data on these two modalities, which may lead to a restoration of the pulmonary function in some of the patients, illustrating once more the fact that bronchitis obliterans syndrome is not always a manifestation of chronic rejection. Copyright © ERS Journals Ltd 2005.

Author-supplied keywords

  • Bronchiolitis obliterans syndrome
  • Chronic rejection
  • Eisenmenger complex/su [Surgery]
  • Lung transplantation
  • acute graft rejection/co [Complication]
  • acute graft rejection/dt [Drug Therapy]
  • azathioprine/dt [Drug Therapy]
  • azithromycin/ct [Clinical Trial]
  • azithromycin/dt [Drug Therapy]
  • azithromycin/pd [Pharmacology]
  • bacterial infection
  • beta 2 adrenergic receptor stimulating agent/dt [D
  • beta 2 adrenergic receptor stimulating agent/ih [I
  • bronchiolitis obliterans/co [Complication]
  • bronchiolitis obliterans/di [Diagnosis]
  • bronchiolitis obliterans/dt [Drug Therapy]
  • bronchiolitis obliterans/et [Etiology]
  • chronic graft rejection/co [Complication]
  • chronic graft rejection/dt [Drug Therapy]
  • chronic graft rejection/et [Etiology]
  • clinical trial
  • cyclosporin A/ae [Adverse Drug Reaction]
  • cyclosporin A/dt [Drug Therapy]
  • cyclosporin/dt [Drug Therapy]
  • cytomegalovirus infection
  • deterioration
  • disease severity
  • drug mechanism
  • drug megadose
  • drug response
  • forced expiratory volume
  • gastroesophageal reflux/co [Complication]
  • gastroesophageal reflux/et [Etiology]
  • gastroesophageal reflux/si [Side Effect]
  • gastroesophageal reflux/su [Surgery]
  • heart lung transplantation
  • human
  • immunosuppressive treatment
  • lung function
  • mycophenolic acid 2 morpholinoethyl ester/dt [Drug
  • priority journal
  • review
  • risk factor
  • steroid/do [Drug Dose]
  • steroid/dt [Drug Therapy]
  • steroid/iv [Intravenous Drug Administration]
  • stomach fundoplication
  • tacrolimus/dt [Drug Therapy]
  • thymocyte antibody/dt [Drug Therapy]
  • transbronchial biopsy

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  • G M Verleden

  • L J Dupont

  • D E Van Raemdonck

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