Abstract
Purpose: Survival following lung transplantation is limited by chronic lung allograft dysfunction (CLAD). Increasingly Bronchiolitis Obliterans Syndrome (BOS), characterized by an obstructive ventilatory defect, is recognized as not the only form of CLAD. As such, we sought to identify characteristic CLAD phenotypes in a large group of lung transplant recipients (LTR) managed at a single centre. Methods and Materials: CLAD was defined as an irreversible decline in FEV1 80% from baseline. 245 patients transplanted between January 2002 and June 2010 were retrospectively reviewed. Spirometry was used to identify CLAD phenotypes: obstructive (BOS), restrictive or a pattern showing both obstruction and reduction in FVC (mixed). Those displaying a restricted or mixed phenotype were further classified by the presence or absence of a persistent infiltrate on CT scan and by histopathology. Results: 119 of 245 LTR were identified as having CLAD: 43 (36%) obstructive, 46 (39%) restrictive and 30 (25%) mixed phenotype. Of those patients with a restrictive or mixed defect, an infiltrate was present in 31 (41%) Ante and post-mortem histological analysis of the lung allograft revealed a novel histopathological phenotype, fibrinoid organizing pneumonia (FOP) in 17 (55%) of these patients. FOP was characterized by obliteration of the alveolar luminae and respiratory bronchioles by fibrinoid material which was not responsive to conventional immunosuppressive regimens. Conclusions: The non-obstructive phenotypes of CLAD appear to have a worse prognosis with survival following FOP being universally poor with time from onset of CLAD to death being less than 12 months (median 215 days; IQR 100 – 282).
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.