Clinical observation of lung transplantation in patients with obstructive bronchiolitis syndrome after hematopoietic stem cell transplantation

Abstract

Objective To investigate the timing and complications of lung transplantation for the treatment of bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation. Methods The clinical data of patients with BOS after hematopoietic stem cell transplantation from January 2012 to September 2015 were collected. Results Eight patients with acute BOS after hematopoietic stem cell transplantation were evaluated and received lung transplantation. The recipient age was 30.88±12.12 years (13-47 years). The lung transplantation was performed 3.44±1.29 years (1-5 years) after BOS. Four patients received bilateral lung transplantation: 2 given single lung transplantation, one given pectus excavatum surgery during the bilateral lung transplantation, and one 1-year-old child given bilateral lobar grafting. Two cases of acute rejection occurred on day 2 and day 9 respectively after transplantation. Four patients experienced early stage aspergillosis infection: one suffering from pulmonary parenchymal invasive infection and the rest 3 cases from anastomotic airway infection. In these 3 cases, one with anastomotic fungal infection and stenosis got poor therapeutic effect by bronchoscopic interventional pluspoosconazole antifungal treatment, and died of lung infection at 6th month after transplantation. Seven patients survived well. The follow-up period ranged from 17 to 47 months after lung transplantation and 35.55 months after bone marrow transplantation. The one-year survival rate after lung transplantation was 87.5%. Conclusion Patients with BOS after hematopoietic stem cell transplantation do not have a high risk of complications such as primary disease, tumor or BOS after lung transplantation, and the survival rate is comparable or even superior to other patients. Lung transplantation for hematopoietic stem cell transplantation after end-stage BOS is safe and effective. Key words: Lung transplantation; Hematopoietic stem cell transplantation; Obliterative bronchiolitis syndrome