ACTUARIAL SURVIVAL OF HEART-LUNG AND BILATERAL SEQUENTIAL LUNG-TRANSPLANT RECIPIENTS WITH OBLITERATIVE BRONCHIOLITIS

Background: Obliterative bronchiolitis is a progressive form of obstru ctive airway disease that threatens long-term survival in lung transpl ant recipients. Its incidence and the long-term survival of lung trans plant recipients with obliterative bronchiolitis are unknown. Methods: The results of 89 heart-lung and 13 bilateral sequential lung transpl ant survivors beyond 90 days of their operation were analyzed. The dat e of diagnosis for obliterative bronchiolitis was established histolog ically (presence of submucosal fibrosis) or physiologically by a persi stent reduction in the forced vital capacity to less than 0.7 for grea ter than 6 weeks. There were 43 patients without obliterative bronchio litis and 59 patients with obliterative bronchiolitis. Results: No dif ferences were found in the mean age and gender ratios between the two groups. The actuarial 1-, 5-, and 10-year percentage freedom from obli terative bronchiolitis was 72 +/- 4.6, 30 +/- 5.6, and 15 +/- 7.4, res pectively, with a median onset of 689 days (range 55 to 3404 days). Ab out half the patients with biopsy-proven obliterative bronchiolitis ha d a fall in their forced expiratory flow at 50% of forced vital capaci ty/forced vital capacity nearly 4 months before fulfilling the forced expiratory volume in 1 second criteria established by the Working Grou p on chronic lung dysfunction. The actuarial 1-, 5-, and 10-year perce ntage survival of obliterative bronchiolitis negative patients was 90 +/- 4.5, 74 +/- 8.4, and 66 +/- 10.6, respectively, versus 90 +/- 3.9, 49 +/- 6.9, and 27 +/- 10.0, respectively, for obliterative bronchiol itis positive patients (p = 0.38). The actuarial 1-, 3-, 5-, 8-, and 1 0-year percentage survival of lung transplant recipients after the dia gnosis of obliterative bronchiolitis was 74 +/- 5.8, 50 +/- 7.5, 43 +/ - 7.8, 23 +/- 8.7, and 11 +/- 9.1, respectively, with a median surviva l of 1084 days (range 0 to 3442 days). Conclusions: The forced expirat ory flow at 50% of forced vital capacity/forced vital capacity is a mo re sensitive indicator for the early detection of obliterative bronchi olitis than the forced expiratory volume in 1 second after heart-lung or bilateral sequential lung transplantation. The obliterative bronchi olitis negative group survival tends to be better than the obliterativ e bronchiolitis positive group. The obliterative bronchiolitis positiv e lung transplant recipients have reasonable outcomes with a median su rvival time of nearly 3 years after the diagnosis of obliterative bron chiolitis. Earlier detection of obliterative bronchiolitis and refinem ents in management may further improve these results.