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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2018, Vol. 12 Issue (2) : 224-228    https://doi.org/10.1007/s11684-017-0538-3
CASE REPORT
Lung transplantation for bronchiolitis obliterans syndrome after allogenic hematopoietic stem cell transplantation
Fei Gao1, Jingyu Chen2(), Dong Wei2, Bo Wu2, Min Zhou2
1. Department of Emergency, Jiangsu Key Lab of Organ Transplantation, Nanjing Medical University, Affiliated Wuxi People’s Hospital, Wuxi 214000, China
2. Transplantation Center, Jiangsu Key Lab of Organ Transplantation, Nanjing Medical University, Affiliated Wuxi People’s Hospital, Wuxi 214000, China
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Abstract

Bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation (HSCT) is a major cause of morbidity and mortality with limited treatment options. Lung transplantation (LTX) has been rarely reported as a treatment option for selected HSCT recipients with this problem. In the present study, we reported six patients who underwent LTX due to BOS after HSCT (two females, four males) from January 2012 to December 2014 in our center. The median time from HSCT to diagnosis of BOS was 2.5 years (ranging from 1 to 5 years). At a median time of 4 years (ranging from 2 to 5 years) after diagnosis of BOS, four patients received bilateral sequential LTX, and two patients received single LTX. One of the recipients suffered from mild acute rejection after LTX, another suffered from primary lung graft dysfunction on post-operation day 2, and three experienced fungal infections. The median time for follow-up after LTX was 19.5 months (ranging from 12 to 39 months). At present, all patients are alive with good functional capacity and no relapse of BOS and hematologic malignancy conditions. Patients who received bilateral LTX have better pulmonary functions than patients who received single LTX.

Keywords bronchiolitis obliterans syndrome (BOS)      hematopoietic stem cell transplantation (HSCT)      lung transplantation (LTX)     
Corresponding Author(s): Jingyu Chen   
Just Accepted Date: 07 July 2017   Online First Date: 28 July 2017    Issue Date: 02 April 2018
 Cite this article:   
Fei Gao,Jingyu Chen,Dong Wei, et al. Lung transplantation for bronchiolitis obliterans syndrome after allogenic hematopoietic stem cell transplantation[J]. Front. Med., 2018, 12(2): 224-228.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0538-3
https://academic.hep.com.cn/fmd/EN/Y2018/V12/I2/224
Sex (male:female) 4:2
Age at HSCT (year) 25.6±10.9
Age at LTX (year) 32.5±11.2
Hematologic disease
ALL
AML
NHL
3 (50)
2 (33)
1 (17)
HSCT
ABMT
HSCT
ABMT+ HSCT
2 (33)
3 (50)
1 (17)
Donor of HSCT
HLA-matched sibling donors
HLA-matched unrelated donor
HLA-haploidentical related donor
1 (17)
2 (33)
3 (50)
Time from HSCT to BOS (year) 3.2±2.4
Time from BOS to LTX (year) 3.8±1.0
PCO2 before LTX (mmHg) 63.6±17.5
PO2 before LTX (mmHg) 55.3±5.6
BMI before LTX (mmHg) 13.1±2.3
Tab.1  Patients’ characteristics
Fig.1  CT scans before and after lung transplantations. (A, B) CT scans of a 23-year-old male (case 1). (C, D) CT scans of a 21-year-old female (case 6). (A) Inspiratory high-resolution CT scan taken right before lung transplantation showing pulmonary emphysema, pneumatocele, and diminution of peripheral vascularity. (B) Inspiratory high-resolution CT scan taken six months after lung transplantation at a similar anatomic level to A. (C) Inspiratory high-resolution CT scan taken right before lung transplantation showing bronchial dilatation and diminution of peripheral vascularity. (D) Inspiratory high-resolution CT scan taken six months after lung transplantation at a similar anatomic level to C.
Fig.2  Pathology findings of a 35-year-old male (case 4). Lung pathology showed massive infiltration of immune cells, severe disruption of the small airway epithelium, and thickening of the underlying smooth muscle and stroma.
Fig.3  Follow-up of FEV1 after lung transplantation.
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