Bronchiolitis Obliterans Syndrome Development in Lung Transplantation Patients

The main cause of death in lung transplantation patients is chronic rejection, known as bronchiolitis obliterans syndrome (BOS). There are many variables associated with its appearance. The aim of this study was to identify factors associated with BOS and its impact on survival among lung transplantation patients. Methods. We retrospectively analyzed charts of lung transplant patients from 1999 to 2009, evaluating survival, BOS, and associated factors. Results. Fifty-six patients have been transplanted with a 5-year survival of 55%. Eighteen (32%) developed BOS, at a mean age at diagnosis of 57 years (range 16-74). According to BOS classification, seven patients (38.8%) were type 2 and six (33.3%) type 3. Half the patients developed BOS at a mean of 8.5 months after transplantation with a mean survival of 18.5 months (range 2-61). Among the factors analyzed, 13 patients (72%) displayed acute cellular rejection and nine (50%) gastroesophageal reflux disease (GERD) diagnosed by pHmetry, both of which were significantly associated with BOS (P = .005). Among seven lung transplantation patients with invasive cytomegalovirus disease, the four who developed BOS (P = .04) showed the worst survival (P = .05). Four of the six patients with severe BOS (66.6%) died at a mean of 10.6 months after the diagnosis. The main cause of death was respiratory insufficiency. Conclusions. BOS was associated with worse survival. The presence of acute cellular rejection episodes, CMV disease, and GERD were factors associated with chronic lung rejection.