Managing Long-Term Issues – Post Lung Transplant

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Is community-acquired respiratory virus infection associated with Bronchiolitis Obliterans Syndroms • Gottlieb J 2009, Prospective Investigations of Community Acquired Virus in lung transplant recipients Community Acquired Respiratory Viruses (CARV) and Risk of BOS • Single center prospective cohort study, Hannover, Germany, Nov 2005- April 2006 • 388 post lung transplant pts screened – viral sxs – URTI sxs: Nasopharyngeal swab for DFA, no PCR – LRTI sxs: Swab + BAL for DFA and PCR • 7.7% of patients enrolled had CARV – Parainfluenza, RSV, metapneumovirus, coronavirus, rhinovirus, influenza Gottlieb, Transplantation 2009 Kumar 2010 Community Acquired Respiratory Viruses & Risk of Bronchiolitis Obliterans Syndrome Community Viruses Risk of BOS 1year incidence of BOS 25% in virus + pts 9% in virus – pts P = 0.01 Gottlieb, Transplantation 2009 Community Acquired Respiratory Viruses and Lung Transplantation • Pathogenesis-Bronchiolitis Obliterans Syndrome (BOS) • Clinical Management Implications – Prevent Exposure – Call transplant center with “cold” symptoms – Vaccination -Danziger L, Transplantation 2010 10
Bronchiolitis Obliterans Challenge: Understanding Mechanism Lung Transplantation “In it for the Long Haul: Long-Term Management” Non- alloimmune factors: • Infection • GERD • Others Increase systemic immune suppression Immune activation Bronchiolitis obliterans Outline •Bronchiolitis Obliterans Syndrome (BOS) -Mortality & Morbidity - Mechanism - Immune and non-immune - Interventions –Complications Post-transplantation -Immunosuppression and morbidity i.e. Infection, cancer •New categories of recipients future management challenges Increased Potential for Infection Aspergillosis in Lung Transplantation • Immunosuppression • Donor lung infection • Acute epithelial injury • Ischemia • Rejection • Mucociliary clearance • No cough reflex • No Lymphatic defense • Airway function • Anastomosis • Obliterative bronchiolitis A Major Problem • Incidence (colonization or disease) 8 - 46% • Invasive Aspergillus mortality rate > 60% • Up to 13% of all post-lung transplant deaths Cahill. 1997 112(5):1160 Nunley Chest. 2002 122(4):1185 Westney. Transplantation. 1996 61(6):915 11
Page 1 and 2: Lung Transplantation “In it for t
Page 3 and 4: Causes of Death Following Lung Tran
Page 5 and 6: Rejection: Newer Categories of Acut
Page 7 and 8: Chiron Briefing Document Figure 2.2
Page 9: Viral Syndrome Post-Transpant Lung
Page 13 and 14: Lung Allocation Score (LAS) Emergen

Managing Long-Term Issues – Post Lung Transplant

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