Work

Outcomes of Lung Transplantation for Bronchiolitis Obliterans after Hematopoietic Stem Cell Transplantation Compared with Those for Idiopathic Pulmonary Fibrosis

Year: 2025

Type: article

Abstract: Purpose: Bronchiolitis obliterans syndrome (BOS) can develop as a manifestation of graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (allo-HSCT), and may ultimately require lung transplantation (LT).However, reports on LT outcomes for BOS after allo-HSCT are limited.This study aimed to compare the outcomes of LT for BOS following allo-HSCT with those for idiopathic pulmonary fibrosis (IPF).Materials and Methods: A total of 487 patients underwent LT between January 2010 and August 2023.Among them, the baseline characteristics and outcomes of 35 patients with BOS following allo-HSCT and 216 patients with IPF were analyzed.Results: The BOS group was younger and had a lower body mass index (BMI) compared to the IPF group (33.7±11.9 years vs. 59.7±7.3 years, p<0.001; 17.6±3.7 kg/m 2 vs. 22.0±3.6 kg/m 2 , p<0.001, respectively).The proportion of male patients was lower in the BOS group than in the IPF group (54.3% vs. 84.3%,p<0.001).Preoperative ventilator support was more common in the BOS group compared to the IPF group (62.9% vs. 32.4%,p=0.001).In Kaplan-Meier survival analysis, the 5-year survival rate was significantly higher in the BOS group than in the IPF group (71.0% vs. 44.9%,p=0.022).In the Cox proportional hazards model, age was the only factor significantly associated with survival [hazard ratio (95% confidence interval): 1.04 (1.02-1.07),p<0.001].Conclusion: The survival rate of the BOS group was not inferior to that of the IPF group after adjusting for sex, age, and BMI.Therefore, LT should be actively considered as a treatment option for patients with BOS following allo-HSCT.

Source: Yonsei Medical Journal

DOI: 10.3349/ymj.2024.0475