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Targeting Allograft Injury and Inflammation in the Management of Post-Lung Transplant Bronchiolitis Obliterans Syndrome

https://doi.org/10.1111/j.1600-6143.2009.02648.xGet rights and content
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Chronic allograft dysfunction, manifesting as bronchiolitis obliterans syndrome (BOS), is the major cause of morbidity and mortality in human lung transplant recipients. While alloimmunity has a definite role, there is increasing interest in overall allograft injury and subsequent inflammation and remodeling. This review deals with nonalloimmune factors that may potentiate alloimmune injury. We discuss infection and reflux/aspiration as examples of allograft injury, which may lead to chronic loss of graft function and BOS. Surgical and nonsurgical treatments aimed at preventing these insults and improving survival are considered. The need for further evidence, including randomized-controlled trials, to evaluate the role of medical and surgical therapies is emphasized by the current literature.

Key words

Antireflux surgery
azithromycin
bronchiolitis obliterans syndrome
lung transplantation
statin

Abbreviations

BALF
bronchoalveolar lavage fluid
BOS
bronchiolitis obliterans syndrome
EMT
epithelial mesenchymal transition
FEV1
forced expiratory volume in 1 second
GERD
gastro-esophageal reflux disease
GMCSF
granulocyte-macrophage colony-stimulating factor
IL
interleukin
MHC
major histocompatibility complex
MMP
matrix metalloproteinases
PPI
proton pump inhibitor
TLR
toll-like receptor

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