TY - JOUR
T1 - Primary pulmonary hypertension as a risk factor for the development of obliterative bronchiolitis in lung allograft recipients
AU - Kshettry, Vibhu R.
AU - Kroshus, Timothy J.
AU - Savik, Kay
AU - Hertz, Marshall I.
AU - Bolman, R. Morton
PY - 1996
Y1 - 1996
N2 - Study objectives: Obliterative bronchiolitis (OB) is a major factor limiting long-term survival after lung transplantation. The etiology of this disease process remains incompletely understated. Several risk factors have been identified previously including acute rejection and cytomegalovirus pneumonitis. The purpose of this study was to evaluate primary pulmonary hypertension (PPH) as a potential risk factor for the development of OB after lung transplantation. Design and patients: We retrospectively analyzed 107 lung allograft recipients (28 heart-lung, 18 bilateral sequential single- lung, 61 single-lung) who underwent transplantation between May 1, 1986, and April 30, 1994, and survived at least 3 months pnsttransplant. Mean follow- up posttransplant was 28.6 months (range, 3.5 to 99 months). Actuarial survival was estimated for patients with or without PPH and for those who did or did not develop OB. Results: In all, 25 patients (23.4%) developed OB diagnosed by strict histologic criteria. Of 23 patients with PPH, 9 (39.1%) developed OB, compared with 16 (19.0%) of 84 patients without PPH (p=0.044). Actuarial survival, sex, time on waiting list, and follow-up posttransplant were not significantly different between groups. PPH was the major determinant for the development of OB (p=0.0468) when evaluating PPH and cytomegalovirus pneumonitis together as risk factors. Patients with PPH also developed OB significantly earlier posttransplant, compared with patients with other primary disease (p=0.05). Conclusions: Patients with PPH who undergo lung transplantation are at increased risk for the development of OB, which also occurs at a shorter time interval posttransplant. This subgroup needs aggressive monitoring for diagnosis and treatment of OB.
AB - Study objectives: Obliterative bronchiolitis (OB) is a major factor limiting long-term survival after lung transplantation. The etiology of this disease process remains incompletely understated. Several risk factors have been identified previously including acute rejection and cytomegalovirus pneumonitis. The purpose of this study was to evaluate primary pulmonary hypertension (PPH) as a potential risk factor for the development of OB after lung transplantation. Design and patients: We retrospectively analyzed 107 lung allograft recipients (28 heart-lung, 18 bilateral sequential single- lung, 61 single-lung) who underwent transplantation between May 1, 1986, and April 30, 1994, and survived at least 3 months pnsttransplant. Mean follow- up posttransplant was 28.6 months (range, 3.5 to 99 months). Actuarial survival was estimated for patients with or without PPH and for those who did or did not develop OB. Results: In all, 25 patients (23.4%) developed OB diagnosed by strict histologic criteria. Of 23 patients with PPH, 9 (39.1%) developed OB, compared with 16 (19.0%) of 84 patients without PPH (p=0.044). Actuarial survival, sex, time on waiting list, and follow-up posttransplant were not significantly different between groups. PPH was the major determinant for the development of OB (p=0.0468) when evaluating PPH and cytomegalovirus pneumonitis together as risk factors. Patients with PPH also developed OB significantly earlier posttransplant, compared with patients with other primary disease (p=0.05). Conclusions: Patients with PPH who undergo lung transplantation are at increased risk for the development of OB, which also occurs at a shorter time interval posttransplant. This subgroup needs aggressive monitoring for diagnosis and treatment of OB.
KW - lung transplantation
KW - obliterative bronchiolitis
KW - primary pulmonary hypertension
UR - http://www.scopus.com/inward/record.url?scp=0030451240&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030451240&partnerID=8YFLogxK
U2 - 10.1378/chest.110.3.704
DO - 10.1378/chest.110.3.704
M3 - Article
C2 - 8797415
AN - SCOPUS:0030451240
SN - 0012-3692
VL - 110
SP - 704
EP - 709
JO - Chest
JF - Chest
IS - 3
ER -