Early outcomes of lung transplantation for bronchiolitis obliterans syndrome after allogeneic haematopoietic stem cell transplantation: a single-centre experience

Abstract

OBJECTIVES: Bronchiolitis obliterans syndrome (BOS) is a serious late complication following allogeneic haematopoietic stem cell transplantation (allo-HSCT) and is associated with chronic graft-versus-host disease. However, the outcome of medical treatment for BOS, mainly immunosuppressive therapy, is disappointing. This study evaluated the early outcomes of lung transplantation (LTx) as a treatment option for severe BOS. METHODS: Between January 2010 and December 2014, we retrospectively reviewed the medical records and postoperative outcomes of 9 patients who underwent LTx for BOS after allo-HSCT at a single institution. RESULTS: The median age of patients at the time of LTx was 21 years, and the median interval from the diagnosis of BOS to LTx was 17.1 months. At the time of LTx, 5 patients were receiving oxygen therapy via nasal prongs, whereas the remaining 4 were receiving mechanical ventilation supports, 2 of whom requiring extracorporeal lung support. All patients underwent bilateral lung transplantation. During a median follow-up of 17 months after LTx, 2 patients died: one of intra-cranial haemorrhage and pneumonia during hospitalization and another patient of pneumonia and septic shock after discharge. Although the follow-up was short, the remaining 7 patients are currently healthy and active except one who developed BOS 45.3 months after LTx: he is on the waiting list for retransplantation. One patient experienced acute rejection that resolved after steroid pulse therapy. There was no relapse of the haematological disease after LTx. CONCLUSIONS: LTx could be a reasonable therapeutic option in selected patients with refractory BOS not responsive to conventional therapy.