Impact of Lung Transplant Operation on Bronchiolitis Obliterans Syndrome in Patients with Chronic Obstructive Pulmonary Disease

• Published in: American journal of transplantation Vol. 6; no. 1; pp. 183 - 189
• Main Authors: Hadjiliadis, D., Chaparro, C, Gutierrez, C, Steele, M P., Singer, L G., Davis, R D., Waddell, T K., Hutcheon, M A., Palmer, S M., Keshavjee, S
• Format: Journal Article
• Language: English
• Published: Oxford UK Munksgaard International Publishers 01-01-2006; Blackwell
• Subjects: Alpha‐1‐antitrypsin deficiency; Biological and medical sciences; Bronchiolitis Obliterans - mortality; Bronchiolitis Obliterans - surgery; chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Errors of metabolism; Female; Humans; lung transplantation; Lung Transplantation - mortality; Male; Medical sciences; Metabolic diseases; Middle Aged; obilterative bronchiolitis; Pneumology; Proteins and glycoproteins; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Syndrome; Treatment Outcome; Transplantation; Operation; Homotransplantation; Respiratory system; Enzymopathy; Alpha-1 -antitrypsin deficiency; Surgery; Bronchus disease; Graft; Bronchiolitis obliterans; Obstructive pulmonary disease; α1-Antitrypsine deficiency; Human; Lung disease; Respiratory disease; Chronic disease; Glycoprotein; Metabolic diseases; Patient; Syndrome; Genetic disease; obilterative bronchiolitis; Chronic; Treatment; lung transplantation; chronic obstructive pulmonary disease
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2005.01159.x

Previous studies suggest that bilateral (BLT) compared with single lung transplantation (SLT) for patients with chronic obstructive pulmonary disease (COPD) results in improved long‐term survival. The effect of transplant operation on bronchiolitis obliterans syndrome (BOS) is unknown. A retrospective study of all lung transplant recipients with pre‐transplant diagnoses of COPD at the University of Toronto and at Duke University was performed. Data collected were age, gender, date and type of transplant, acute rejection, survival, presence and time of BOS. 221 (bilateral n = 101, single n = 120) patients met our criteria. Patients with BLT were younger (53.0 vs. 55.3 years; p = 0.034), more likely to be male (56.3% vs. 42.4%; p = 0.039) and more likely to be transplanted at the University of Toronto (79.6% vs. 16.1%; p < 0.001). Freedom from BOS was similar at 1 year post‐transplant. However, BLT recipients were more commonly free from BOS 3 years (57.4% vs. 50.7%) and 5 years (44.5% vs. 17.9%) post‐transplant (p = 0.024). Survival of BLT was better than SLT recipients at 3 and 5 years post‐transplant (BLT vs. SLT: 67.5% vs. 61.1% and 60.7% vs. 34.1%, respectively; p = 0.018). Similar trends on survival were observed after development of BOS. BLT results in lower rates of BOS in patients with COPD that are eligible for both SLT and BLT.