ABSTRACT
Lung and heart-lung transplantation (LTx and HLTx) are now accepted operative therapeutic interventions for well-selected patients with end-stage heart-lung or lung disease. Although the procedure remains a palliation therapy, most of the patients are doing well with, nowadays, a mean actuarial five-year survival of 40% to 50% (1), even increasing to over 60% to 70% for selected indications such as cystic fibrosis and emphysema in some high volume centers (2,3). Although the surgical techniques and the immunosuppressive drug regimen have improved and new techniques for early detection of chronic rejection have emerged, long-term survival is hampered by the development of chronic rejection. Indeed, obliterative bronchiolitis (OB) or bronchiolitis obliterans syndrome (BOS), the clinical correlate of OB, is now regarded as a manifestation of chronic rejection (4), leading to obliteration and scarring of the terminal bronchioles, and remains the leading cause of morbidity and of late mortality after HLTx or LTx (1).
