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1 From the Cedars-Sinai Medical Center, Pulmonary Division, Department of Medicine, Los Angeles
2 From the Department of Cardiothoracic Surgery, UCLA School of Medicine, Los Angeles
The presentation and clinical course of bronchiolitis obliterans (BO) in single-lung transplant (SLT) recipients has thus far not been well described. We retrospectively analyzed the serial spirometry of 15 SLT patients with BO. All the patients fulfilled the criteria for BO syndrome, and 11 of the 15 had histologically documented BO. Based on serial FEV1 analysis, we identified three patterns of presentation and progression of BO. The first pattern (n=6) was characterized by a rapid onset and a relentless progressive course; the second pattern (n=5) was characterized by a similar rapid onset and initial rapid decline, but was followed by stabilization in lung function; the third pattern (n=4) was characterized by an insidious onset and course. In all patients, a permanent reduction in the mean forced expiratory flow during the middle half of the forced vital capacity appeared to be an early sensitive index for the development of BO. An appreciation of these different modes of presentation and progression of BO is potentially important in the assessment of prognosis and management of the SLT recipient.
Key Words: bronchiolitis obliterans • chronic rejection • lung transplantation • spirometry
Submitted on April 4, 1994
Accepted on August 17, 2007
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