Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliter
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RESEARCH ARTICLE
Open Access
Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliterans syndrome Mohammed Fakhro1*, Ellen Broberg2, Lars Algotsson2, Lennart Hansson3, Bansi Koul1, Ronny Gustafsson1, Per Wierup1, Richard Ingemansson1 and Sandra Lindstedt1
Abstract Background: Survival after lung transplantation (LTx) is often limited by bronchiolitis obliterans syndrome (BOS). Method: Survey of 278 recipients who underwent LTx. The endpoint used was BOS (BOS grade ≥ 2), death or Relung transplantation (Re-LTx) assessed by competing risk regression analyses. Results: The incidence of BOS grade ≥ 2 among double LTx (DLTx) recipients was 16 ± 3% at 5 years, 30 ± 4% at 10 years, and 37 ± 5% at 20 years, compared to single LTx (SLTx) recipients whose corresponding incidence of BOS grade ≥ 2 was 11 ± 3%, 20 ± 4%, and 24 ± 5% at 5, 10, and 20 years, respectively (p > 0. 05). The incidence of BOS grade ≥ 2 by major indications ranked in descending order: other, PF, CF, COPD, PH and AAT1 (p < 0. 05). The mortality rate by major indication ranked in descending order: COPD, PH, AAT1, PF, Other and CF (p < 0. 05). Conclusion: No differences were seen in the incidence of BOS grade ≥ 2 regarding type of transplant, however, DLTx recipients showed a better chance of survival despite developing BOS compared to SLTx recipients. The highest incidence of BOS was seen among CF, PF, COPD, PH, and AAT1 recipients in descending order, however, CF and PF recipients showed a better chance of survival despite developing BOS compared to COPD, PH, and AAT1 recipients. Keywords: Lung transplantation, Bronchiolitis obliterans, Graft rejection, Graft survival, Survival rate
Background Chronic lung allograft dysfunction (CLAD) remains the major barrier to long-term success after lung transplantation [1–3]. The primary cause of death after LTx is CLAD. The development of CLAD is rare in the first year after LTx, but the rate increases quickly with cumulative incidence reported to be as high as 40% to 80% within the first five years [4–7]. CLAD that manifests early after transplantation reportedly shows a poorer prognosis than late-onset CLAD. Bronchiolitis obliterans (BO) is the pathologic pattern of injury most commonly seen in lung transplant recipients with progressive loss of lung * Correspondence: [email protected] 1 Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden Full list of author information is available at the end of the article
function. It is believed to be due to chronic allograft rejection and is characterized by the obliteration of small airways by fibromyxoid granulation tissue. Distribution is patchy and difficult to detect with transbronchial biopsy [3, 7]. Because BO is difficult to document histologically, the International Society for Heart and Lung Transplantation (ISHLT) in 1993 established criteria for its physiologic counterpart, bronchiolitis obliterans syndrome (BOS). This diagnosis requires a perma
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