DEVELOPMENT OF BRONCHIOLITIS OBLITERANS SYNDROME IN RECIPIENTS OF HEART-LUNG TRANSPLANTATION EARLY RISK

Given the internationally recognized definition of bronchiolitis oblit erans syndrome (BOS) and longer follow up of heart-lung transplant rec ipients, it is possible to establish some of the major risk factors fo r development and progression of BOS, Between April 1984 and 31 Decemb er 1993, 157 patients underwent heart-lung transplantation; 126 surviv ed at least six months after operation and so were at risk of developi ng BOS, The following early risk factors were assessed for development of BOS grade 1 (21-35% decline in FEV(1)), and progression from grade 1 to grade 2 (36-50% decline in FEV(1)): age, gender and underlying d iagnosis of the recipient, evidence of acute rejection and cytomegalov irus (CMV) infection within 6 months of operation, peak FEV(1) achieve d, age and gender of the donor, cold ischemic time of the graft, and m atching of CMV serological status and HLA antigens of donor and recipi ent, The number of acute rejection episodes observed remained the sing le most important determinant of development of BOS grade 1 (relative risk 1.17 (1.06, 1.29), P=0.002) and progression to BOS grade 2 (relat ive risk 1.58 (1.02, 2.48), P=0.03), No other factors were significant ly related to development or progression of BOS, although both evidenc e of CMV infection and disease and the number of HLA mismatches increa sed the risk, Bronchiolitis obliterans syndrome is a major problem for medium-to-long-term survivors of cardiothoracic transplantation. Acut e rejection early after transplantation is a sensitive prognostic indi cator of subsequent functional decline and requires prompt attention.