Yonsei Med J.  2012 Sep;53(5):1054-1057.

Lung Transplantation for Bronchiolitis Obliterans after Allogeneic Hematopoietic Stem Cell Transplantation

• Kim YR
• Haam SJ
• Park YG
• Lim BJ
• Park YM
• Paik HC

Abstract

Bronchiolitis obliterans (BO) is a late onset complication of allogeneic hematopoietic stem cell transplantation (HSCT), and treatment outcome is dismal if it does not respond to immunosuppressive therapy. A 21-year-old male diagnosed with acute myeloid leukemia received an allogeneic HSCT from human leukocyte antigen- identical sibling donor. Twenty one months after transplantation, he developed progressive dyspnea and was diagnosed BO. Despite standard immunosuppressive therapy, the patient rapidly progressed to respiratory failure and Novalung(R) interventional lung-assist membrane ventilator was applied in the intensive care unit. Three months after the diagnosis of BO, the patient underwent bilateral lung transplantation (LT) and was eventually able to wean from the ventilator and the Novalung(R). Since the LT, the patient has been under a strict rehabilitation program in order to overcome a severe lower extremity weakness and muscle atrophy. Histologic findings of the explanted lungs confirmed the diagnosis of BO. Nine months after the LT, the patient showed no signs of rejection or infectious complications, but still required rehabilitation treatment. This is the first LT performed in a patient with BO after allogeneic HSCT in Korea. LT can be an effective therapy in terms of survival for patients with respiratory failure secondary to development of BO following HSCT.

Keyword

Lung transplantation; bronchiolitis obliterans; chronic graft versus host disease

MeSH Terms

Bronchiolitis Obliterans*
Bronchiolitis*
Diagnosis
Dyspnea
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Intensive Care Units
Korea
Leukemia, Myeloid, Acute
Leukocytes
Lower Extremity
Lung Transplantation*
Lung*
Male
Membranes
Muscular Atrophy
Rehabilitation
Respiratory Insufficiency
Siblings
Tissue Donors
Treatment Outcome
Ventilators, Mechanical
Young Adult

Figure

• 

  Fig. 1 Chest computed tomography. Diffuse bronchiectasis and airtrapping in both lungs with peribronchial graund glass opacity more predominantly in both upper lobe. It is consistent with underlying bronchiolitis obliterans combined with pneumonia.

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  Fig. 2 Microscopic findings of the lung. The biopsy showed the obliterated bronchiole and patchy interstitial fibrosis and intraalveolar collection of histiocytes (A: H&E stain ×100, B: H&E stain ×200).

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