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Other Treatments for Bronchiolitis Obliterans Syndrome

  • Ramsey HachemEmail author
Chapter
Part of the Respiratory Medicine book series (RM, volume 8)

Abstract

Bronchiolitis obliterans syndrome (BOS) remains the leading obstacle to better long-term outcomes after lung transplantation. The incidence of BOS approaches 50 % within 4 years of transplantation, and the median survival after the diagnosis of BOS is approximately 3 years. Because BOS is generally thought to represent chronic alloimmune-mediated rejection, the mainstay of therapy has been intensifying immunosuppression. However, the response to treatment is poor, and the typical clinical course is characterized by progressive allograft dysfunction. Total lymphoid irradiation (TLI) and extracorporeal photopheresis (ECP) are used at some centers, although they are usually reserved as salvage treatments for refractory BOS. Re-transplantation is the ultimate treatment option, but the donor organ shortage and generally marginal outcomes have limited its widespread use.

Keywords

Bronchiolitis obliterans syndrome Total lymphoid irradiation Extracorporeal photopheresis Forced expiratory volume in one second (FEV1Survival 

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Washington University School of Medicine/Barnes-Jewish Hospital Pulmonary and Critical CareSt. LouisUSA

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