An international ISHLT/ATS/ERS clinical practice guideline: Diagnosis and management of bronchiolitis obliterans syndrome

ISHLT/ATS/ERS BOS Task Force Committee

Research output: Contribution to journalArticle

198 Citations (Scopus)

Abstract

Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS. A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations. The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of posttransplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS. The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention.

Original languageEnglish (US)
Pages (from-to)1479-1503
Number of pages25
JournalEuropean Respiratory Journal
Volume44
Issue number6
DOIs
StatePublished - Dec 1 2014

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Bronchiolitis Obliterans
Practice Management
Practice Guidelines
Allografts
Lung
Azithromycin
Lung Transplantation
Forced Expiratory Volume
Tacrolimus
Cyclosporine

Cite this

An international ISHLT/ATS/ERS clinical practice guideline : Diagnosis and management of bronchiolitis obliterans syndrome. / ISHLT/ATS/ERS BOS Task Force Committee.

In: European Respiratory Journal, Vol. 44, No. 6, 01.12.2014, p. 1479-1503.

Research output: Contribution to journalArticle

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abstract = "Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS. A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations. The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of posttransplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS. The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention.",
author = "{ISHLT/ATS/ERS BOS Task Force Committee} and Meyer, {Keith C.} and Ganesh Raghu and Verleden, {Geert M.} and Corris, {Paul A.} and Paul Aurora and Wilson, {Kevin C.} and Jan Brozek and Glanville, {Allan R.} and Egan, {Jim J.J.} and Selim Arcasoy and Aris, {Robert M.} and Avery, {Robin K.} and John Belperio and Juergen Behr and Sangeeta Bhorade and Annette Boehler and Cecilia Chaparro and Christie, {Jason D.} and Dupont, {Lieven J.} and Marc Estenne and Fisher, {Andrew J.} and Garrity, {Edward R.} and Denis Hadjiliadis and Hertz, {Marshall I} and Martin Iversen and Shaf Keshavjee and Lama, {Vibha N.} and Levine, {Deborah J.} and Levine, {Stephanie M.} and Lee, {James C.} and Gilbert Massard and Mehta, {Atul C.} and Nathan, {Steven D.} and Orens, {Jonathan B.} and Palmer, {Scott M.} and Snell, {Greg I.} and Marc Stern and Studer, {Sean M.} and Sweet, {Stuart C.} and Tazelaar, {Henry D.} and Whelan, {Timothy P.} and Wilkes, {David S.} and Williams, {Trevor J.} and Zamora, {Martin R.}",
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AU - Christie, Jason D.

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AU - Estenne, Marc

AU - Fisher, Andrew J.

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AU - Hadjiliadis, Denis

AU - Hertz, Marshall I

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AU - Sweet, Stuart C.

AU - Tazelaar, Henry D.

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N2 - Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS. A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations. The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of posttransplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS. The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention.

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