BRONCHIOLITIS OBLITERANS ORGANIZING PNEUMONIA (BOOP) IN LUNG-TRANSPLANT RECIPIENTS

We reviewed all tissue specimens from 163 transplant patients (10S dou ble lung transplant [DLT], 55 single lung transplant [SLT]) between No vember 1983 and January 1994 for abnormalities indicating bronchioliti s obliterans organizing pneumonia (BOOP) and found 17 cases (14 DLT an d 3 SLT). Of the three SLTs, BOOP tvas diagnosed by open lung biopsy ( OLB) in two and one was found at autopsy. Of the 14DLTs, BOOP was diag nosed by transbronchial biopsy (TBB) specimens (9), OLB specimens (2), autopsy (1), TBB and OLB specimens (1), and OLB specimens and autopsy (1), BOOP was found between 1 and 43 months posttransplantation; time of survival from diagnosis was between 2 and 36 months with 9 patient s presently alive, Concurrent pathologic diagnosis at the time of BOOP findings were as follows: acute rejection (7) (grade I [4] and grade 2 [3]), BO and grade 1 rejection (2), BO and grade 2 rejection (2), BO and Aspergillus infection (1), acute alveolar injury (I), acute alveo lar injury and pulmonary embolus (1), acute rejection (grade 1) and Bu rkholderia cepacia pneumonia (I). No other pathologic diagnosis was fo und in I patient, In total, I I of 17 patients (65%) had associated ac ute rejection, Of the 17 patients, 7 subsequently developed BO and 3 h ad BO before the finding of BOOP, Death occurred in 8 patients (5 DLT and the 3 SLT) between 2 and 6 months after the diagnosis. We conclude that BOOP is an important complication after lung transplantation; it was present in 13% of DLTs and 5% of SLTs, BOOP was most often associ ated with acute rejection.