Tag: bronchiolitis obliterans

Bronchiolitis Obliterans After Lung Transplantation: Retransplantation

It is extremely difficult to draw definitive conclusions about the effectiveness of the aforementioned interventions for the treatment of BO. The majority of reports consist of anecdotal, single-center, nonrandomized, and uncontrolled investigations with relatively small sample sizes. In addition, it appears that most reports indicate stabilization or slowing of the rate of loss of lung […]

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Bronchiolitis Obliterans After Lung Transplantation: Other Immune-Modulating Therapies

Other immune-modulating treatment strategies used against BO include extracorporeal photochemotherapy, plasmapheresis, total lymphoid irradiation, and allogeneic bone marrow transplantation to achieve chimerism. To date, the numbers of patients treated with these strategies are too small to be conclusive. Extracorporeal photochemotherapy has been approved for use in cutaneous T-cell lymphoma and appears to be effective for […]

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Bronchiolitis Obliterans After Lung Transplantation: Inhaled Immunosuppressive Drugs

Inhaled Immunosuppressive Drugs Targeted delivery of immunosuppressive agents directed to the graft has been applied in experimental systems for years. The rationale for targeted delivery was to achieve higher local levels of the drug with less systemic toxicity. Additionally, it has been hypothesized that the drug may act along pathways not accessible from the systemic […]

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Bronchiolitis Obliterans After Lung Transplantation: Tacrolimus

Tacrolimus Tacrolimus as a substitute for cyclosporine was shown anecdotally to stabilize the course of two patients with BO. A large randomized trial of 133 patients compared tacrolimus to cyclosporine as first-line immunosuppressive therapy. Patients receiving tacrolimus had fewer acute rejection episodes per 100 patient-days (0.85±0.72) compared with the patients given cyclosporine (1.09 ±0.72), although […]

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Bronchiolitis Obliterans After Lung Transplantation: Short-term Heightened Immunosuppression

Although no protocol is universally accepted for the treatment of BO, augmentation of corticosteroids and cytolytic therapy have been used as initial therapies in the past. Occasionally, presumed acute rejection (ie, an abrupt decline of a previously stable lung function, absence of infection, and nondiagnostic or inadequate histologic examination) may be the initial manifestation of BO; it […]

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Bronchiolitis Obliterans After Lung Transplantation: Clinical Course of BO

Clinical Course of BO Three distinct patterns of presentation and progression in the clinical course of BO have been described. The first pattern is characterized by a rapid onset followed by a relentlessly progressive course, usually leading to death due to respiratory failure within 1 year of diagnosis. The second pattern is characterized by a similar […]

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Bronchiolitis Obliterans After Lung Transplantation: Bronchoscopy and Lung Biopsy

Ventilation/perfusion scanning in BO usually reveals a decline in ventilation that is most prominent in the peripheral parts of the lung. In patients with BO after single lung transplantation for primary pulmonary hypertension, the decline in ventilation with well preserved perfusion often results in severe ventilation/perfusion mismatch. Bronchoscopy and Lung Biopsy In the clinical setting, […]

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