Tags

Type your tag names separated by a space and hit enter

The impact of cytolytic therapy on bronchiolitis obliterans syndrome.
J Heart Lung Transplant. 1998 Sep; 17(9):869-75.JH

Abstract

BACKGROUND

Bronchiolitis obliterans syndrome (BOS) is the major cause of morbidity and death after lung transplantation. Therapy has focused on augmented immunosuppression with a variety of agents. Although transient responses are often achieved, sustained remission has been unusual. The outcome of cytolytic therapy for BOS at our center has been analyzed and is reported.

METHODS

Between July 1988 and July 1994, 233 patients underwent lung transplantation at Barnes-Jewish Hospital. Among 207 recipients (88.8%) who survived more than 3 months, 81 recipients (39%) had development of BOS; 48 of these patients underwent 64 courses of treatment with a cytolytic agent (antilymphocyte globulin, antithymocyte globulin, or OKT3 monoclonal antibody). The cases of BOS were retrospectively analyzed to determine the impact of cytolytic therapy.

RESULTS

The 4-year survival rate was significantly greater in recipients without BOS than in those with BOS (82.8% vs 46.0%; p < .05). Various clinical factors, including diagnosis, forced expiratory volume in 1 second at onset of BOS, presence or absence of pathologically proven bronchiolitis obliterans, type of transplant operation, cytomegalovirus serologic status, and cytomegalovirus pneumonia, were examined, but no significant predictor of survival after the development of BOS was discerned. The mean decrement in forced expiratory volume in 1 second was significantly reduced by cytolytic therapy (-23.5% +/- 2.3% in the 3 months before therapy vs -9.9% +/- 3.5% in the 3 months after the therapy; p < .002). Nevertheless, the stage of BOS progressed over time in spite of therapy in most cases, and only 4 recipients (4.9%) with BOS remained in a lower BOS stage 2 years after treatment.

CONCLUSIONS

Recipients with BOS had a significantly lower survival rate than recipients without BOS. No predictor of survival after the onset of BOS was identified. Although cytolytic therapy decreased the rate of decline in pulmonary function in the 3 months after treatment, the stage of BOS ultimately progressed in most patients.

Authors+Show Affiliations

Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

9773858

Citation

Date, H, et al. "The Impact of Cytolytic Therapy On Bronchiolitis Obliterans Syndrome." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 17, no. 9, 1998, pp. 869-75.
Date H, Lynch JP, Sundaresan S, et al. The impact of cytolytic therapy on bronchiolitis obliterans syndrome. J Heart Lung Transplant. 1998;17(9):869-75.
Date, H., Lynch, J. P., Sundaresan, S., Patterson, G. A., & Trulock, E. P. (1998). The impact of cytolytic therapy on bronchiolitis obliterans syndrome. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 17(9), 869-75.
Date H, et al. The Impact of Cytolytic Therapy On Bronchiolitis Obliterans Syndrome. J Heart Lung Transplant. 1998;17(9):869-75. PubMed PMID: 9773858.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of cytolytic therapy on bronchiolitis obliterans syndrome. AU - Date,H, AU - Lynch,J P, AU - Sundaresan,S, AU - Patterson,G A, AU - Trulock,E P, PY - 1998/10/17/pubmed PY - 1998/10/17/medline PY - 1998/10/17/entrez SP - 869 EP - 75 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 17 IS - 9 N2 - BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is the major cause of morbidity and death after lung transplantation. Therapy has focused on augmented immunosuppression with a variety of agents. Although transient responses are often achieved, sustained remission has been unusual. The outcome of cytolytic therapy for BOS at our center has been analyzed and is reported. METHODS: Between July 1988 and July 1994, 233 patients underwent lung transplantation at Barnes-Jewish Hospital. Among 207 recipients (88.8%) who survived more than 3 months, 81 recipients (39%) had development of BOS; 48 of these patients underwent 64 courses of treatment with a cytolytic agent (antilymphocyte globulin, antithymocyte globulin, or OKT3 monoclonal antibody). The cases of BOS were retrospectively analyzed to determine the impact of cytolytic therapy. RESULTS: The 4-year survival rate was significantly greater in recipients without BOS than in those with BOS (82.8% vs 46.0%; p < .05). Various clinical factors, including diagnosis, forced expiratory volume in 1 second at onset of BOS, presence or absence of pathologically proven bronchiolitis obliterans, type of transplant operation, cytomegalovirus serologic status, and cytomegalovirus pneumonia, were examined, but no significant predictor of survival after the development of BOS was discerned. The mean decrement in forced expiratory volume in 1 second was significantly reduced by cytolytic therapy (-23.5% +/- 2.3% in the 3 months before therapy vs -9.9% +/- 3.5% in the 3 months after the therapy; p < .002). Nevertheless, the stage of BOS progressed over time in spite of therapy in most cases, and only 4 recipients (4.9%) with BOS remained in a lower BOS stage 2 years after treatment. CONCLUSIONS: Recipients with BOS had a significantly lower survival rate than recipients without BOS. No predictor of survival after the onset of BOS was identified. Although cytolytic therapy decreased the rate of decline in pulmonary function in the 3 months after treatment, the stage of BOS ultimately progressed in most patients. SN - 1053-2498 UR - https://www.unboundmedicine.com/medline/citation/9773858/The_impact_of_cytolytic_therapy_on_bronchiolitis_obliterans_syndrome_ L2 - http://www.diseaseinfosearch.org/result/971 DB - PRIME DP - Unbound Medicine ER -