MYCOPHENOLATE MOFETIL FOR OBLITERATIVE BRONCHIOLITIS SYNDROME AFTER LUNG TRANSPLANTATION

Background. The development of obliterative bronchiolitis after lung t ransplantation portends a poor longterm outcome because of progressive decline in allograft function. There are currently no effective means of treating this condition. Methods. Thirteen patients in whom oblite rative bronchiolitis syndrome developed after lung transplantation wer e treated with mycophenolate mofetil, an antimetabolite immunosuppress ant, at a dose of 1.5 g orally twice daily. Patients were followed up clinically and with pulmonary function testing. Results. Duration of m ycophenolate mofetil therapy ranged from 1 week to 24 months (mean dur ation, 11.4 months). Pulmonary function test results stabilized in the majority of patients with no significant further decline in forced ex piratory volume in 1 second. Two patients died of progressive oblitera tive bronchiolitis, 1 patient is alive with progressive disease, and 1 patient died of an acute infection. The drug was discontinued in 2 ad ditional patients. In no patient did severe leukopenia or cytomegalovi rus infection develop; 1 patient had a fungal infection, and 7 patient s experienced gastrointestinal side effects. Conclusions. In the setti ng of obliterative bronchiolitis syndrome, mycophenolate mofetil is ge nerally well tolerated and is associated with stabilization of pulmona ry function test results. These findings suggest that the otherwise pr ogressive process of obliterative bronchiolitis can be slowed. (C) 199 7 by The Society of Thoracic Surgeons.