Post-transplant o obstructive llung d disease (("bronchiolitis obliterans"): a a c clinical c comparative s study o of b bone m marrow a and llung transplant p patients

Post-transplant obstructive lung disease ("bronchiolitis obliterans"): a clinical compar- ative study of bone marrow and lung transplant patients. F. Philit, T. Wiesendanger, E. Archimbaud, J-F. Mornex, J. Brune, J-F. Cordier. ERS Journals Ltd 1995. ABSTRACT: Patients at a single pulmonary centre who developed obstructive lung disease after bone marrow transplantation (BMT) and lung transplantation (LT) were studied, in order to compare the clinical expression of post-transplant obstruc- tive lung disease (PTOLD) (bronchiolitis obliterans) in these two conditions, which have so far been studied separately. Nine out of 179 patients surviving more than 100 days after BMT (5%) and 9 out of 44 patients surviving more than 100 days after LT (20%) developed post- transplant obstructive lung disease. This was defined by an irreversible airflow obstruction, as characterized by a forced expiratory volume in one second divided by forced vital capacity (FEV1/FVC) of less than 70%, and a FEV1 of less than 70% of predicted value. The mean interval between transplantation and the diagnosis of post-transplant obstructive lung disease was 262 days and 217 days for BMT and LT patients, respectively. In all cases, pulmonary symptoms consisted of dyspnoea and pro- gressively productive cough. Bronchial dilatation on high-resolution computed tomography scans was the main imaging feature present in both groups of patients at the onset of post-transplant obstructive lung disease. The mean FEV1/FVC ratio was 51 and 54% for BMT and LT patients, respectively. All BMT and LT patients had normal transfer coefficient. Clinical chronic graft-versus-host disease was pre- sent in all BMT patients before or concurrent with the onset of post-transplant obstructive lung disease, and all LT patients had presented at least one episode of acute lung rejection. Five BMT and six LT patients died of respiratory failure at means of 397 and 228 days, respectively, after the onset of post-transplant obstruc- tive lung disease. Other patients remained stable or improved after increasing immunosuppressive therapy. These data suggest that clinical, radiological, and functional presentation of obs- tructive lung disease after lung or bone marrow transplantation is quite similar in both conditions.