Original ArticlesMycophenolate Mofetil for Obliterative Bronchiolitis Syndrome After Lung Transplantation
Section snippets
Material and Methods
Starting in July 1995, patients with OBS after lung transplantation at The University of Michigan were offered the opportunity to receive MMF as an alternative to azathioprine as part of their standard immunosuppression regimen. The drug was administered as part of an institutional review board–approved study, and informed consent was obtained. All patients met the criteria for the development of OBS: a greater than 20% drop in forced expiratory volume in 1 second (FEV1) and temporally
Results
Between June 1995 and August 1996, 13 patients were diagnosed as having OBS after lung transplantation. Baseline patient characteristics, including severity of OB [3], are listed in Table 1. There were 5 men and 8 women; the mean age was 48 years (range, 19 to 60 years). The reason for transplantation was chronic obstructive pulmonary disease in 8 patients, pulmonary fibrosis in 2 patients, sarcoidosis in 2 patients, and primary pulmonary hypertension in 1 patient. Nine patients underwent
Comment
Bronchiolitis obliterans remains the major cause of late mortality and morbidity in lung transplant recipients. It occurs with increasing frequency the longer patients are followed after transplantation and has a prevalence of greater than 50% in patients with a follow-up longer than 32 months 2, 4. The majority of patients experience a progressive decline in pulmonary function, and the mortality rate associated with the condition is greater than 40% 2, 4.
Three potential treatment strategies
References (19)
- et al.
Post-transplant obliterative bronchiolitis and other late sequelae in human heart-lung transplantation
Chest
(1984) - et al.
Prevalence and outcome of bronchiolitis obliterans syndrome after lung transplantation
Ann Thorac Surg
(1995) - et al.
Obliterative bronchiolitis after lung and heart-lung transplantation
Ann Thorac Surg
(1995) - et al.
Bronchiolitis obliterans in single-lung transplant recipients
Chest
(1995) - et al.
Inhibition of chronic vascular rejection in primate cardiac xenografts using mycophenolate mofetil
Ann Thorac Surg
(1994) - et al.
Clinical trial of tacrolimus versus cyclosporine in lung transplantation
Ann Thorac Surg
(1995) - et al.
Delayed development of obliterative bronchiolitis syndrome with OKT3 after unilateral lung transplantation. A plea for multicenter immunosuppressive trials
Chest
(1996) - et al.
A working formulation for the standardization of nomenclature and clinical staging of chronic dysfunction in lung allografts
J Heart Lung Transplant
(1993) - et al.
Purine metabolism and immunosuppressive effects of mycophenolate mofetil (MMF)
Clin Transplant
(1996)
Cited by (60)
Chronic Lung Allograft Dysfunction
2021, Encyclopedia of Respiratory Medicine, Second EditionObservational Study of Methotrexate in the Treatment of Bronchiolitis Obliterans Syndrome
2016, Transplantation ProceedingsBronchiolitis
2012, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Few therapies improve outcomes in patients once BOS has developed, and despite advances in the early detection and treatment of acute rejection, the prevalence of BOS has not appreciably changed in recent years.79 Changing the primary immunosuppressive regimen (ie, converting cyclosporine to tacrolimus or azathioprine to mycophenolate mofetil) has been shown in small studies to stabilize the course of BOS.81,82 Extracorporeal photopheresis (ECP) and total lymphoid irradiation (TLI) have been shown to slow the decline in lung function in patients with BOS, although the side effects of TLI may be poorly tolerated.83–86
Esophageal motor dysfunction and gastroesophageal reflux are prevalent in lung transplant candidates
2010, Annals of Thoracic SurgeryCitation Excerpt :These abnormalities contributed to the higher prevalence of abnormal distal esophageal acid exposure in the IPF subgroup. Abnormal esophageal acid exposure was common in LTx candidates, corroborating previous reports of a high prevalence of GER in patients with advanced lung disease [10, 11, 28, 29]. One in 3 LTx candidates had abnormal acid exposure in the distal esophagus.
Mycophenolate mofetil reduces alveolar inflammation, acute rejection and graft loss due to bronchiolitis obliterans syndrome after lung transplantation
2010, Pulmonary Pharmacology and Therapeutics