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The safety and efficacy of total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation

Lookup NU author(s): Professor Paul Corris

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Abstract

Total lymphoid irradiation (TLI) has been used to control renal and cardiac allograft rejection. Data evaluating TLI in bronchiolitis obliterans syndrome (BOS), the physiological manifestation of chronic lung allograft rejection, is very limited. We present our single center experience of the safety and efficacy of TLI in controlling progressive BOS in a retrospective study. Over 12 years, 37 lung recipients (16 M:21 F) who had undergone 13 single; 12 bilateral and 12 heart-lung transplants were treated with TLI for progressive BOS. Grades at time TLI given were BOS 1 (n = 7) BOS 2 (n = 14) BOSS (n = 16). Twenty-seven (73%) completed >8/10 fractions, 10 (27%) failed to complete TLI. Two died from advanced BOS during treatment, 8 stopped early (range 3-7 fractions) due to marrow suppression (6) or infection (2). In the 27 recipients who completed >8/10 fractions, decline in FEV1 was 122.7 mis/month pre-TLI and 25.1 mis/month post-TLI, p = 0.0004, mean (95% CI) change in rate of decline was 97.5 (48.2-146.7) mis/month. TLI significantly reduces the rate of decline in graft function associated with BOS. TLI is well tolerated and associated with few serious complications and is an appropriate immunosuppressive approach in progressive BOS. Copyright © Blackwell Munksgaard 2004.


Publication metadata

Author(s): Fisher AJ, Rutherford RM, Bozzino J, Parry G, Dark JH, Corris PA

Publication type: Article

Publication status: Published

Journal: American Journal of Transplantation

Year: 2005

Volume: 5

Issue: 3

Pages: 537-543

Print publication date: 01/03/2005

ISSN (print): 1600-6135

ISSN (electronic): 1600-6143

Publisher: Wiley-Blackwell

URL: http://dx.doi.org/10.1111/j.1600-6143.2004.00709.x

DOI: 10.1111/j.1600-6143.2004.00709.x

PubMed id: 15707408


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