Bronchiolitis obliterans syndrome in lung transplantation: risk factors and markers for development of the disease:

Pattern and Predictors of Early Rejection After Lung Transplantation

• Background Most lung transplant recipients experience improvement in their underlying pulmonary condition but are faced with the threat of allograft rejection, the primary determinant of long-term survival. Several studies examined predictors of rejection, but few focused on the early period after transplantation.

• Objectives To describe the pattern and predictors of early rejection during the first year after transplantation to guide the development of interventions to facilitate earlier detection and treatment of rejection.

• Methods Data for donor, recipient, and posttransplant variables were retrieved retrospectively for 250 recipients of single or double lung transplants.

• Results Most recipients (85%) had at least 1 episode of acute rejection; 33% had a single episode; 23% had recurrent rejection; 3% had persistent rejection; 13% had refractory rejection; and 14% had clinicopathological evidence of chronic rejection. Serious rejection (refractory acute rejection or chronic rejection) developed in 27% of recipients. Compared with other recipients, recipients who had serious rejection had more episodes of acute rejection (P = .004), and the first acute episodes occurred sooner after transplantation (P = .01) and were of a higher grade (P = .002).

• Conclusions Recipients who experienced higher grades for their first episode of acute rejection (P=.03) and higher cumulative rejection scores (P = .004) were significantly more likely than other recipients to have serious rejection during the first year after transplantation.

Bronchiolitis obliterans syndrome

BOS remains a difficult problem to control following lung transplantation, largely because of uncertainties regarding the underlying mechanisms that are responsible for it. Continued work on the pathogenesis of BOS is essential. The progressive nature and poor outlook when BOS stage 3 is reached indicates that current strategies should be focused on prevention and early intervention. There is a great need for randomized, controlled trials on intervention if the international transplant community is to make progress in this area.