DOES BRONCHIAL ARTERY REVASCULARIZATION INFLUENCE RESULTS CONCERNING BRONCHIOLITIS OBLITERANS SYNDROME AND OR OBLITERATIVE BRONCHIOLITIS AFTER LUNG TRANSPLANTATION/

Objective: To study the frequency of histological obliterative bronchi olitis and clinical bronchiolitis obliterans syndrome after en bloc do uble lung transplantation with bronchial artery revascularization and bilateral lung transplantation without bronchial artery revascularizat ion. Methods: Primary en bloc double lung transplantation with bronchi al artery revascularization using the internal mammary artery as condu it was performed in 62 patients. The frequencies of obliterative bronc hiolitis and bronchiolitis obliterans syndrome have been established f rom transbronchial biopsies and lung function measurements. Results ha ve been analyzed in relation to the arteriographic success of bronchia l artery revascularization and have been compared to results from Stan ford University, obtained through personal communications. Results: Su rvival after 1, 2, 3, 4 and 5 years was 85, 81, 69, 69, and 69%, respe ctively. Fifteen patients developed bronchiolitis obliterans syndrome while seven developed obliterative bronchiolitis. Survival was superio r for patients with bronchial artery revascularization classified as c omplete or incomplete bilateral versus incomplete hemilateral, incompl ete poor or failed (P = 0.016, log-rank test). For patients surviving greater than or equal to 3 months post-transplant, the post-operative baseline FEV1 was lower for patients who later developed bronchiolitis obliterans syndrome compared to patients who did not (P = 0.007). The development of bronchiolitis obliterans syndrome and obliterative bro nchiolitis were both correlated to observation time post-transplant bu t not to the number of rejections or infections when corrected for obs ervation time. Conclusions: In a subgroup of lung transplant patients, a process in the transplanted lungs, eventually leading to bronchioli tis obliterans syndrome diagnosis, seems to start in the donor during the transplantation and/or in the early post-operative cause. A compar ison with results after bilateral lung transplantation without bronchi al artery revascularization suggests that good direct bronchial artery revascularization may postpone the onset of bronchiolitis obliterans syndrome and obliterative bronchiolitis. The positive trend motivates further use of direct bronchial artery revascularization in lung trans plantation. (C) 1998 Elsevier Science B.V. All rights reserved.