Skip to main content
SpringerLink
Log in

Diagnosis and Management of Bronchiolitis Obliterans (Chronic Rejection): Retransplantation

  • Chapter
The Transplantation and Replacement of Thoracic Organs

  • 94 Accesses

Abstract

The detailed features of chronic rejection following heart—lung transplantation are as yet inadequately defined. Any discussion of these late complications requires an understanding of the physiology of the heart—lung bloc after implantation, and the factors that may superimpose changes in these variables. This chapter will attempt to outline the cardiac and pulmonary changes that can occur in the later period following transplantation, and current thoughts on chronic rejection and other late sequelae.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Dawkins, K.D., Hunt, S.A., Jamieson, S.W., Theodore, J., Oyer, P.E, Stinson, E.B. and Shumway, N.E. (1984). Heart-lung transplantation for pulmonary vascular disease: follow-up hemodynamic data. J. Am. Coll. Cardiol., 3, 596

    Google Scholar 

  2. Dawkins, K.D., Jamieson, S.W., Hunt, S.A, Baldwin, J.C., Burke, C.M., Morris, A., Billingham, H.E., Theodore, J., Oyer, P.E. and Stinson, E.B. (1985). Long-term results, hemodynamics and complications after combined heart and lung transplantation. Circulation, 71, 912

    Article  Google Scholar 

  3. Theodore, J., Burke, C., Dawkins, K., Jamieson, S.W., Stinson, E.B., Van Kessel, A., Shumway, N.E. and Robin, E.D. (1984). Circulatory versus respiratory limitations to exercise before and after human heart—lung transplantation. J. Am. Coll. Cardiol., 3, 509

    Google Scholar 

  4. Herran, J.J., Theodore, J., Van Kessel, A., Reitz, B., Jamieson, S., Stinson, E. and Robin, E.D. (1984). Appropriate ventilatory response to exercise in human heart—lung transplantation. Clin. Res., 31, 417A

    Google Scholar 

  5. Burke, C.M., Baldwin, J.C., Morris, A.J., Shumway, N.E., Theodore, J., Tazelaar, H.D., McGregor, C., Robin, E.D. and Jamieson, S.W. (1987). Twenty-eight cases of human heart—lung transplantation. Lancet, 1, 517

    Google Scholar 

  6. Dawkins, K.D., Burke, C.M., Baldwin, J.C., Theodore, J. and Jamieson, S.W. (1984). Long-term complications of combined heart and lung transplantation. Circulation, 70, II 690

    Google Scholar 

  7. Morris, A.J.R., Burke, C.M., Dawkins, K.D., Yousem, S., Billingham, H., McGregor, C.G., Baldwin, J.C., Blank, N., Jamieson, S. and Theodore, J. (1985). Late clinical results of heart—lung transplantation. Am. Rev. Respir. Dis., 131, A87

    Google Scholar 

  8. Theodore, J., Jamieson, S.W., Burke, C.M., Reitz, B.A., Stinson, E.B., Van Kessel, A., Dawkins, K.D., Herran, J.J., Oyer, P.E, Hunt, S.A, Shumway, N.E. and Robin, E.D. (1984). Physiological aspects of human heart—lung transplantation: pulmonary function status of the post-transplanted lung. Chest, 86, 349

    Article  PubMed  CAS  Google Scholar 

  9. Burke, C.M, Morris, A.J, Dawkins, K.D, Yousem, S, Blank, N, McGregor, C, Baldwin, J.C, Theodore, J. and Jamieson, S.W. (1985). Obliterative bronchiolitis and chronic pulmonary rejection. J. Heart Transplant, 4, 144

    Google Scholar 

  10. Dawkins, K.D. and Jamieson, S.W. (1986). Pulmonary function of the transplanted lung. Ann. Rev. Med., 37, 263

    Article  PubMed  CAS  Google Scholar 

  11. Griffith, B.P, Hardesty, R.C, Trento, A, Paradis, I.L, Duquesnoy, R.J, Zeevi, A, Dauber, J.H, Dummer, J.S, Thompson, M.E, Gryzan, S. and Bahnson, H.T. (1987). Heart-lung transplantation: lessons learned and future hopes. Ann. Thorac. Surg., 43, 6

    Article  PubMed  CAS  Google Scholar 

  12. Theodore, J, Reitz, B, Jamieson, S, Herran, J.J, Van Kessel, A, Stinson, E. and Robin, E.D. (1983). Persistence of bronchial tone in human transplanted lung. Clin. Res., 31, 514A

    Google Scholar 

  13. Robin, E.D, Theodore, J. and Burke, C.M. (1987). Hypoxic pulmonary vasoconstriction persists in the human transplanted lung. Clin. Sci., 72, 283

    PubMed  CAS  Google Scholar 

  14. Burke, C.M, Theodore, J, Dawkins, K.D, Yousem, S.A, Blank, N, Billingham, M.E, Van Kessel, A, Jamieson, S.W, Oyer, P.E, Baldwin, J.C, Stinson, E.B, Shumway, N.E. and Robin, E.D. (1984). Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart—lung transplantation. Chest, 86, 824

    Article  PubMed  CAS  Google Scholar 

  15. Burke, C.M, Morris, A.J.R, Dawkins, K.D, McGregor, C.G, Yousem, S.A, Allen, M, Theodore, J, Harvey, J, Billingham, M.E, Oyer, P.E, Stinson, E.B, Baldwin, J.C, Shumway, N.E. and Jamieson, S.W. (1985). Late airflow obstruction in heart—lung transplantation recipients. J. Heart Transplant., 4, 437

    PubMed  CAS  Google Scholar 

  16. Yousem, S.A, Burke, C.M. and Billingham, M.E. (1985). Pathologic pulmonary alterations in long-term human heart—lung transplantation. Hum. Pathol., 16, 911

    Article  PubMed  CAS  Google Scholar 

  17. Reynolds, H.Y. (1987). Bronchoalveolar lavage. Am. Rev. Respir. Dis., 135, 250

    PubMed  CAS  Google Scholar 

  18. Gryzan, S, Paradis, I.R, Dauber, J.H, Hardesty, R.L. and Griffith, B.P. (1985). The role of bronchoalveolar lavage (BAL) in monitoring patients after heart—lung transplantation (H/L Tx). J. Heart Transplant., 4, 134

    Google Scholar 

  19. Gryzan, S, Paradis, I.R., Griffith, B, Hardesty, R. and Dauber, J. (1985). Bronchoalveolar lavage cell profile after heart—lung transplantation (H/L Tx). Chest, 88, 35

    Google Scholar 

  20. Gryzan, S, Paradis, I.L., Hardesty, R.L., Griffith, B.P. and Dauber, J.H. (1985). Bronchoalveolar lavage in heart—lung transplantation. J. Heart Transplant., 4, 414

    PubMed  CAS  Google Scholar 

  21. Paradis, I.L., Marrari, M., Zeevi, A., Duquesnoy, R., Griffith, B.P., Hardesty, R.L. and Dauber, J.H. (1985). The transition of lung lavage cells from donor to recipient phenotype after heart—lung transplantation. J. Heart Transplant., 4, 138

    Google Scholar 

  22. Paradis, I.L., Marrari, M., Zeevi, A., Duquesnoy, R.J., Griffith, B.P, Hardesty, R.L. and Dauber, J.H. (1985). HLA phenotype of lung lavage cells following heart—lung transplantation. J. Heart Transplant., 4, 422

    PubMed  CAS  Google Scholar 

  23. Duquesnoy, F.J, Zeevi, A, Fung, J, Paradis, I, Dauber, J, Griffith, B. and Hardesty, R.L. (1985). Functional characterization of lymphocytes in bronchoalveolar lavages from heart—lung transplant patients. J. Heart Transplant., 4, 135

    Google Scholar 

  24. Zeevi, A, Fung, J.J, Paradis, I.L, Dauber, J.H, Griffith, B.P, Hardesty, R.L. and Duquesnoy, R.J. (1985). Lymphocytes of bronchoalveolar lavages from heart—lung transplant recipients. J. Heart Transplant., 4, 417

    PubMed  CAS  Google Scholar 

  25. Kirby, J.A, Reader, J.A. and Pepper, J.R. (1986). Lung transplantation: effect of cyclosporin-A on the frequency of cytolytic lymphocytes recovered from blood and the bronchoalveolar space. J. Heart Transplant., 5, 33

    PubMed  CAS  Google Scholar 

  26. Hoefter, E, Reichenspurner, H, Krombach, F, Kemkes, B.M, Fiehl, E, Kugler, C, Ertel, W, Osterholzer, G, Konig, G, Gokel, J.M. and Hammer, C. (1987). Morphology and function of free lung cells following combined hetero-orthotopic heart—lung transplantation in the dog. Transplant. Proc., 19, 1045

    PubMed  CAS  Google Scholar 

  27. Haverich, A, Dawkins, K.D, Baldwin, J.C, Reitz, B.A, Billingham, M.E. and Jamieson, S.W. (1985). Long-term cardiac and pulmonary histology in primates following combined heart and lung transplantation. Transplantation, 39, 356

    Article  PubMed  CAS  Google Scholar 

  28. Castaneda, A.R, Zamora, R, Schmidt-Habelman, P, Hornung, J, Murphy, W, Ponto, D. and Moller, J.H. (1972). Cardiopulmonary autotransplantation in primates (baboons): late functional results. Surgery, 72, 1064

    PubMed  CAS  Google Scholar 

  29. Dawkins, K.D, Haverich, A, Derby, G.C, Scott, W.C, Reitz, B.A, Stinson, E.B, Jamieson, S.W. and Shumway, N.E. (1985). Long-term hemodynamics following combined heart and lung transplantation in primates. J. Thorac. Cardiovasc. Surg., 89, 55

    PubMed  CAS  Google Scholar 

  30. Veith, F.J. and Hagstrom, J. (1972). Alveolar manifestations of rejection: an important cause of the poor results with human lung transplantation. Ann. Surg., 175, 336

    Article  PubMed  CAS  Google Scholar 

  31. Veith, F.J, Montefusco, C, Kamholz, S.L. and Mollenkopf, F.P. (1983). Lung transplantation. J. Heart Transplant., 2, 155

    Google Scholar 

  32. Allen, M.D, Burke, C.M, McGregor, C.G.A, Baldwin, J.C, Jamieson, S.W. and Theodore, J. (1986). Steroid-responsive bronchiolitis after human heart—lung transplantation. J. Thorac. Cardiovasc. Surg., 92, 449

    PubMed  CAS  Google Scholar 

  33. Epier, G. and Colby, T. (1983). The spectrum of bronchiolitis obliterans. Chest, 83, 161

    Article  Google Scholar 

  34. Deffenbach, M.E, Charon, N.B., Lakshminarayan, S. and Butler, J. (1987). The bronchial circulation: small, but a vital attribute to the lung. Am. Rev. Respir. Dis., 135, 463

    Google Scholar 

  35. Garzon, A.A, Goldstein, S, Okadigwe, C.I, Paley, N.B. and Minkowitz, S. (1977). Hypothermic lung preservation functions, six or more years later. Ann. Surg., 186, 711

    Article  PubMed  CAS  Google Scholar 

  36. Hino, K, Grogan, J.B. and Hardy, J.D. (1968). Viability of stored lungs. Transplantation, 6, 25

    Article  PubMed  CAS  Google Scholar 

  37. Cohen, R.G, Hoyt, G, Billingham, M.E, Bieber, C.P, Jamieson, S.W. and Shumway, N.E. (1984). Myocardial fibrosis due to cyclosporin in rat heterotopic heart transplantation. Heart Transplant., 3, 355

    Google Scholar 

  38. Billingham, M.E. (1987). Cardiac transplant atherosclerosis. Transplant. Proc., 19, 19

    PubMed  CAS  Google Scholar 

  39. Porter, K. (1974). Renal transplantation. In Hepinstall, R.H. (ed.) Pathology of the Kidney. (Boston: Little, Brown)

    Google Scholar 

  40. Karch, S.B. and Billingham, M.E. (1985). Cyclosporin-induced myocardial fibrosis: a unique controlled case report. Heart Transplant., 4, 210

    CAS  Google Scholar 

  41. Ralph, D.D, Springmeyer, S.C, Sullivan, K.M, Haekman, R.C, Storb, R. and Thomas, E.D. (1984). Rapidly progressive air flow obstruction in marrow transplant recipients: possible association between obliterative bronchiolitis and chronic graft-versus-host disease. Am. Rev. Respir. Dis., 129, 641

    PubMed  CAS  Google Scholar 

  42. Wyatt, S.E, Nunn, P, Hows, J.M, Yin, J, Hayes, M.C, Catovsky, D, Gordon-Smith, E.C, Hughes, J.M, Goldman, J.M. and Galton, S. (1984). Airways obstruction associated with graft-versus-host disease after bone marrow transplantation. Thorax, 39, 887

    Article  PubMed  CAS  Google Scholar 

  43. Tazelaar, H.D, Prop, J, Nieuwenhuis, P, Billingham, M.E. and Wildevuur, C.R.H. (1987). Obliterative bronchiolitis in the transplanted rat lung. Transplant. Proc., 19, 1052

    PubMed  CAS  Google Scholar 

  44. Jamieson, S.W, Dawkins, K.D, Burke, C, Baldwin, J.W, Yousem, S, Billingham, M.E, Hunt, S.A., Reitz, B.A. Theodore, J, Oyer, P.E, Stinson, E.B. and Shumway, N.E. (1985). Late results of combined heart—lung transplantation. Transplant. Proc., 17, 212

    Google Scholar 

  45. Starnes, V.A. and Jamieson, S.W. (1986). Current status of heart and lung transplantation. World J. Surg., 10, 442

    Article  PubMed  CAS  Google Scholar 

  46. Yacoub, M.H, Banner, N.R, Gibson, S, Thakkar, S.A. and Khaghani, A. (1987). A quantitative assessment of the quality of life after combined heart—lung transplantation. J. Am. Coll. Cardiol., 9, 30A

    Google Scholar 

Download references

Authors
  1. R. S. Bonser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Y. Tarazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. W. Jamieson
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Baptist Medical Center, Oklahoma Transplantation Institute, Oklahoma City, Oklahoma, USA

    David K. C. Cooper MA, MD, PhD, FRCS (Cardiothoracic Surgeon and Director of Research and Education, Formerly, Associate Professor of Cardiothoracic Surgery) & Dimitri Novitzky MD, FCS (SA) (Cardiothoracic Surgeon, Formerly, Specialist in Cardiothoracic Surgery) (Cardiothoracic Surgeon and Director of Research and Education, Formerly, Associate Professor of Cardiothoracic Surgery) &  (Cardiothoracic Surgeon, Formerly, Specialist in Cardiothoracic Surgery)

  2. University of Cape Town Medical School and Groote Schuur Hospital, Cape Town, South Africa

    David K. C. Cooper MA, MD, PhD, FRCS (Cardiothoracic Surgeon and Director of Research and Education, Formerly, Associate Professor of Cardiothoracic Surgery) (Cardiothoracic Surgeon and Director of Research and Education, Formerly, Associate Professor of Cardiothoracic Surgery)

  3. Groote Schuur Hospital, Cape Town, South Africa

    Dimitri Novitzky MD, FCS (SA) (Cardiothoracic Surgeon, Formerly, Specialist in Cardiothoracic Surgery) (Cardiothoracic Surgeon, Formerly, Specialist in Cardiothoracic Surgery)

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Kluwer Academic Publishers

About this chapter

Cite this chapter

Bonser, R.S., Tarazi, R.Y., Jamieson, S.W. (1990). Diagnosis and Management of Bronchiolitis Obliterans (Chronic Rejection): Retransplantation. In: Cooper, D.K.C., Novitzky, D. (eds) The Transplantation and Replacement of Thoracic Organs. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0711-9_43

Download citation

  • DOI: https://doi.org/10.1007/978-94-009-0711-9_43

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6805-5

  • Online ISBN: 978-94-009-0711-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation