REVERSIBLE CAUSE OF BRONCHIOLITIS OBLITERANS SYNDROME(BOS) - Yavuz Silay

1. American Transplant Congress
May 5-9 2007
Abstract Number: 952638
Keyword 1: Lung transplantation Keyword 2: Graft function Keyword 3: Morbidity Keyword 4: Post-operative
complications
Abstract Title: REVERSIBLE CAUSE OF BRONCHIOLITIS OBLITERANS SYNDROME(BOS)
Ramesh Kesavan, MD1, Gnananandh Jayaraman, MD1, Tarik Haddad, MD1, Nadine Haykal2, Osama Gaber,
MD2, Yavuz Silay, MD1, Linda Moore2, Mathias Loebe, MD2, Scott Scheinin, MD2 and Harish Seethamraju,
MD1.
1Pulmonary Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States and
2The Methodist Hospital, Houston, Texas, United States.
Body: OBJECTIVE: Airway complications are a significant cause of morbidity and mortality in lung transplant
patients. The objective of our study was to analyse the impact of Bronchial stenosis (BS) on graft function.
METHODS: A longitudinal prospective study was performed on patients who underwent lung transplant in our
institution between January 2004 to December 2005. Patients who did not survive the initial transplant
hospitalization were excluded.
RESULT: Over a period of 2 years, 23 out of 34 patients were followed up. The mean age of the transplanted
patients was 51. Thirteen (57%) patients had BS, of which 9(39%) patients had airway stent placed. The
remaining 10 (43%) patients did not have any airway complications. Stents were placed in symptomatic patients
who had a decline in FEV1 in association with BS. The mean days to stent was 142 days.Patients with a
diagnosis of Pulmonary Fibrosis(IPF) were more prone for anastamotic narrowing (66% of all IPF patients
transplanted, p-0.0468) as against any other diagnosis. Age, sex, CMV status, reperfusion injury, number of
ventilator days, double vs single lung transplant, ischemic time, infections in the first three months, acute
rejection did not influence the incidence of BS. The rate of decline of FEV1 in patients who had stent placement
was significantly worse compared to patients who did not have an airway complication (p<.0001). The mean
FEV1 in patients with stent placed was 1.91 as against 2.4 in patients with no airway complications. Four
patients (17%) had only an endoscopic intervention done but no stent placed.. These patients had an
improvement in FEV1 with time after the intervention (p-0.0009). Two of the 23 patients died, however there
was no statistical significance in survival between the patients with BS as against those without BS.
CONCLUSION: Lung transplant patients with airway complication and a drop in FEV1 requiring stent
placement have a more rapid decline in their FEV1 over time as compared to patients with no airway
complication. Airway stent was placed only in symptomatic patients with a decrease in FEV1 which did not alter
the progression of graft loss. The authors suggest that early intervention should be attempted prior to a drop in
FEV1 to possibly alter the progression of graft loss and a reversible cause of BOS.